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Flashcards in lecture 8 Deck (34):
1

When do you screen for primary prevention of CAD/CVA?

beginning at age 20 & repeated Q4-6 years in those without establisted or cerebrovascular disease

2

what does ASCVD stand for

atherosclerotic cardiovascular disease

3

what does CAD/CHD stand for?

coronary artery disease

4

what does CVA stand for?

cerebrovascular accident
stoke/TIA

5

why do you screen for primary prevention?

systematically identify risk factors for CAD/CVA-> provide 10-yr risk-> use data to encourage risk factor modification

6

if age 40-79 use

-a 10-yr pooled cohort risk eqn to estimate short-term ASCVD risk
- performs well in non-hispanic black & whites.

7

if age 20-39 or low risk (<7.5%) & age 40-59

- use a 30-yr framingham score
- provides more useful data t facilitate risk modification in young people since they may have low 10-yr risk despite risk factors (smoking, DM, HTN)

8

HTN primary prevention w/o compelling indications

ACEI/ARB or thiazide or CCB

9

HTN coronary artery disease

beta-blocker & ACEI/ARB

10

HTN recurrent stroke prevention

thiazide +/- ACEI

11

HTN CDK or DM

ACEI/ARB

12

systemic approach to assessment/prevention of CAD & CVA

- HTN
-dyslipidemia
- DM
- lifestyle
- antithrombotic?

13

DM

- lifestyle changes & pharmacological management w/ individualized A1C target
- glycemic control does not generally reduce CV events but will prevent progression of microvascular complications (neuropathy, nephropathy, retinopathy
- if impaired fasting glucose or glucose intolerance is present, perform lifestyle modifications to prevent progression to frank DM

14

Lifestyle

- complete cessation of tobacco
- obesity: target BMI 18.5-24.9 (10% in 6 mo)
- diet
- exercise: >40 mod intensity activity 3-4 days/wk
- cardiac rehab: recommended for those with a history of CAD, esp after MI & chronic stable angina
- alcohol: <1drink/day in women

15

antithrombotic approach will be specific to

the disease state, sex, age & risk of atheroembolic vs. cardioembolic events

16

atheroembolic events

- where plaque rupture may/has caused a MI or stroke/TIA, therapy is spearheaded by antiplt agents
- atheroembolic-> ASA

17

cardioembolic events

- where abnormal blood flow/inflammation/ endothelial damage puts you at risk od activation of clotting factors lead to a stroke/TIA (or DVT/PE) therapy is focused on anticoagulants
- cardioembolic->coumadin

18

atherosclerotic cardiovascular diease (ASCVD)
"silent"

- >50^ obstruction of coronary artery
- chronic stable angina
- carotid artery disease
- PAD

19

atherosclerotic cardiovascular diease (ASCVD) overt/"hard"

- ACS
-stroke/TIA

20

primary prevention

- meaures taken to prevent onset of disease (decr or stop atherosclerosis leading to ASCVD)
-i.e. prevent CAD/CSA/MI/stroke/TIA by controlling BP, dyslipidemia, tobacco abuse, lifestyle factors & potentially initiating antithrombotic therapy for high-risk pts (ASA)

21

secondary prevention

- measures taken to prevent recurrence/progression of diagnosed ASCVD
- i.e. prevent CAD/CSA/MI/stroke/TIA by controlling BP, dyslipidemia, tobacco abuse, lifestyle factors & INITIATING antithrombotic therapy for ALL pts w/out CI

22

CV risk

- 5 fingers!
- HTN
- dyslipidemia
- DM
- lifestyle
- antithrombotic

23

coronary artery disease

- arterial sclerosis leads to plaque rupture. plts play a large role in treatment & prevention hence antiplts (i.e. ASA/plavix/etc)

24

atheroembolid stroke

- arterial sclerosis leads to plaque rupture. plts play a large role in treatment & prevention hence antiplts (i.e. ASA/plavix/etc)

25

cardioembolic stroke

- abnormal flow/ inflammation/ endothelial leads to activation of clotting factors (anticoagulants for afib)

26

MI

ASA +/- plavix, effient, brillinta

27

DVT or PE

warfarin or xarelto

28

atheroembolic stroke

plavix
aggrenox
ASA

29

cardioembolic stroke (Afib or valve disease)

anticaogulant (warfarin, xarelto, eliquis, pradexa)

30

DVT/PE or cardioembolic stroke (Afib or valve disease)

- primary prevention
- thrombo/cardioembolic
- anticoagulant>antiplt

31

MI or atheroembolic stroke

-secondary prevention
- atheroembolic event
- antiplt>anticoagulant

32

CHADSVASC score

-C: congestive HF=1
-H:HTN=1
-A:Age>75=2
-D:DM=1
-S: stroke/TIA/embolism=2
-V: vascular disease=1
-A:Age65-74=1
-Sc:Sex category (female)=1

33

CHADSVASc therapy

0= no therapy
1= ASA or anticoag
>/=2= anticoag

34

calculate CHADSVASc score in pts with

atrial fibrillation
or valve replacement