Final - Cardiovascular Conditions

Question 1

Modifiable Risk Factors of CAD

Answer 1

• Dislipidemia
• Smoking
• Hypertension
• Diabetes
• Obesity
• Thrombogenic Factors
• Sedentary Lifestyle

Question 2

Non-Modifiable Risk Factors for CAD

Answer 2

• Family history of CAD
• Age
• Sex

Question 3

Levels of Risk Associated with CAD

Answer 3

• Hypertension: DBP >90
• Smoking
• Serum total cholesterol level >240 mg/Dl

Question 4

What does high blood pressure put you at risk for?

Answer 4

stroke and heart disease

leading causes of death in US

Question 5

High blood pressure increases risk of:

Answer 5

• CAD
• Stroke
• heart failure
• PAD
• AD
• chronic kidney disease
• Dementia (vascular, Alzheimer’s)
• Mild Cognitive Deficits

Question 6

Who gets hypertension?

Answer 6

• more common in older people
• males > females up to age 64
• females > males after age 65
• more common and severe in african americans
• positive family history
• obesity
• diabetics

Question 7

For persons over age 50, what is the more important number as a CAD risk factor?

Answer 7

SBP rather than DBP

Question 8

What does blood pressure vary with?

Answer 8

• strength of the heartbeat
• elasticity of the arterial walls
• volume and viscosity of the blood
• health, age, and physical condition of a person
• location of measurement

Question 9

Hypertensive readings are based on the average of what?

Answer 9

two or more readings taken at two or more visits

Question 10

Primary HTN

Answer 10

• AKA Essential HTN
• accounts for 95% of cases of HTN
• no universally established cause

Question 11

Secondary HTN

Answer 11

• less common cause (5%)

- secondary to other potentially rectifiable causes

Question 12

Identifiable causes of Secondary Hypertension

Answer 12

• sleep apnea
• drug induced or related causes
• CKD
• primary aldosteronism
• renovascular disease
• chronic steroid therapy or Cushing’s syndrome
• Pheochromocytoma
• Coarctation or the aorta
• Thyroid of Parathyroid disease

Question 13

Renin Angiotensin Aldosterone System

Answer 13

Slide 19

Question 14

Symptoms of HTN

Answer 14

• headache
• dizziness
• blurred vision
• shortness of breath (especially with exertion)
• chest pain
• rapid pulse, palpitations
• malaise and fatigue
• *frequently no symptoms at all

Question 15

Elevated BP

Answer 15

120-129 / < 80

Treated with lifestyle modifications

Question 16

Stage 1 HTN

Answer 16

130-139 / 80- 89

treated with lifestyle modification and medication for those with CVD

Question 17

Stage 2 HTN

Answer 17

> 140 / >90

Treated with life style modification and medications

Question 18

Lifestyle and diet modifications to reduce blood pressure

Answer 18

• weight reduction
• adopt DASH eating plan
• dietary sodium reduction
• physical activity
• moderation of alcohol reduction

Question 19

Anti-hypertensive Medications

Answer 19

• Thiazide type diuretics
• ACE
• Beta Blockers
• Calcium channel blockers
• Angiotensin Receptor blockers

Question 20

ACE inhibitors

Answer 20

ends in -pril

Question 21

Angiotensin Receptor Blockers

Answer 21

end in -artan

Question 22

Beta blockers

Answer 22

ends in -lol

Question 23

Calcium channel blockers

Answer 23

ends in -ipine

Question 24

What can thiazide type diuretics induce?

Answer 24

hypokalemia

Hydrocholorthiazide or Chlorthalidone

Question 25

What do ACE inhibitors do?

Answer 25

blocks the conversion of Angiotensin I to Angiotensin II

Question 26

What do calcium channel blockers do?

Answer 26

- slows SA node | - slows heart rate and lowers blood pressure

Question 27

Types of Acute Coronary Syndromes (ACS)

Answer 27

- unstable angina (no permanent damage) | - MI (non ST elevation MI or ST elevation MI)

Question 28

Vulnerable Plaque

Answer 28

contains: - T Lymphocyes - macrophage foam cell - activated intimal SMC - normal medal SMC

Question 29

Angina

Answer 29

- occurs with activity, stress - pain is described as pressure, squeezing, heaviness, may be associated with diaphoresis, nausea or vomiting and/or shortness of breath - relieved with rest or nitroglycerin (relieved after 2-5 mins)

Question 30

Immediate treatment for NSTEMI

Answer 30

- anti-ischemic - anti-platelet/ anti-thrombotic - invasive strategy - cardiac cath

Question 31

Anti-ischemic Rx

Answer 31

- best rest - nitroglycerin - oxygen --> at least 92% - morphine --> relaxing and vasodilating - Beta Blocker (metoprolol) - possibly calcium channel blocker (verapamil) - ACE inhibitor for decreased LV function

Question 32

Anti-Platelet/ Anti-thrombotic Rx

Answer 32

- Aspirin - Heparin --> prevents clot from getting bigger - Add platelet Gb IIb/IIIa receptor antagonist

Question 33

STEMI Criteria

Answer 33

- elevated serial enzymes | - ST elevation in 2 or more leads (dont even wait for blood work to come back)

Question 34

Immediate Rx for STEMI

Answer 34

- Anti-ischemic - Anti-platelet/ anti-thrombotic - invasive strategy: cardiac cath/ PCI within 90 minutes of presentation

Question 35

Hospital Discharge Care

Answer 35

``` Aspirin and Anticoagulants Beta Blockers and Blood Pressure Cholesterol and Cigarettes Diet and Diabetes Education and Exercise ```

Question 36

Candidates for Cardiac Cath

Answer 36

- MI - Known CAD - Positive stress test - Not reach target heart rate on stress test - possible heart failure - structural deformities - identified bacterial infection

Question 37

Goal of Cardiac Cath (left system)

Answer 37

- identify location of CAD (if any) for PCA or CABG - Measure left ventricle ejection fracture - if needed, measure aortic valve

Question 38

Risk of Cardiac Procedure

Answer 38

- Very rare, death, MI, stroke, renal failure - bleeding 2-5% (biggest risk) - allergic reaction to dye

Question 39

Patient population for Percutaneous Transluminal Coronary Artery (PTCA/Stent)

Answer 39

- blockage greater than 70% - pt is a candidate for CABG - - left main disease - - proximal LAD - - triple vessel disease

Question 40

PTCA/ Stent Protocols

Answer 40

- Pts typically stay in bed for 4-6 hrs after procedure - May resume regular activities in 4-5 days - Pt discharged from hospital 1 day after procedure - If received stent, discharged on anticoagulant