Ischrmic Heart Disrase Flashcards
Low risk
Less than 1% annual death
Duke score 5 No ischemic symptoms on max ETT No ischemia on EKG No stress induced wall motion abnormalities Coronary stenosis less than 50% Minimal perfusion defect <5% Cac score less than 100
Angina
Typical sscp provoked by activity relieved with nitro
Atypical angina meet 2 characteristics
Non cardiac. One or none
Intermediate risk
1-3% mi death
EF 35-49% Wallmotion abnormality 2 segment and 1 coronary area Cac score 100-399 2 vessel on CTA 50-69% One vessel >70% St changes 1mm on stress test with sx Stress ischemia in multiple segments 5-9.9% myocardium at risk
High risk >3% annual risk
Cac >400 EF 35% or less Stress induced LV dilatation Ischemia in 2 territories Inducible ischemia at low work load Multi vessel >70% LM greater than 50% Vt VF Std more than 2 mm 10% drop in EF More than 10% muscle at risk
Stable ischemic heart disease
May use plavix is pt is largo to asprin
Guide line directed therapy
Moderate to high dose statin may consider bile acid or niacin
HTN below 140/90 acei for CHF and DM
Diabetes appropriate glycemic control
BP management
Life style weight loss
Drug therapy for greater than 140/90
Acei, bb, ca blockers, thiazides
Diet
Less than 5 gm salt per day
Saturated fats less than 10%
30-45 gm fiber
Weight loss
40 inces for men
35 inches for women
Influenza vaccine
Class 1 indication
Class 1 for chronic stable cad
Lipids bmp Carotid us Echo EKG Cxr
Asa plavix
75-162 for cad. Class 1
Plavix if you can’t take Asa
Class 2b Asa and plavix
Class 3 persantine
Beta blockers class 1
Normal EF use for 3. Years
EF less than 40% for life
Renin blockers p
Ace first choice
ARB second line
Nitrates
Don’t use in HOCM or with Viagra
