Preventative Cardiology

Question 1

Smoking Cessation

Answer 1

eventually reduces risk of CV dz to that of non-smoker (w/in 15 years)

Question 2

High intensity Statin

Answer 2

atorvastatin 40-80mg

rosouvastatin 20-40mg

Question 3

When to start BP Therapy

Answer 3

2 or more readings >140/90 (<80yo)
>80yo = >150/90
If +CVA, CAD, TIA, PAD, AAA, DM, CKD >130/80

Question 4

Smoking cessations

Answer 4

1. Buproprion
2. Varenicline if history of SEIZURES (ie on keppra)
   (can cause depression/loss of focus- d/c if this happens)

Question 5

HIV Cardiomyopathy

Answer 5

Protease inhibitors worsen lipid profile
NO simvastatin or lovastatin
Liptor 10 or crestor 10 indicated (low dose statins)
Treat TG>500

Question 6

OSA - untreated risks

Answer 6

r/o Afib

inc’d risk of SCD during sleep only

Question 7

Cholesterol guidelines

Answer 7

1) individuals with known clinical ASCVD defined as CHD, stroke, and peripheral arterial disease
2) primary elevations of LDL-C ≥190 mg/dl (i.e., familial hypercholesterolemia)
3) individuals with diabetes ages 40-75 years with LDL-C 70-189 mg/dl and without clinical ASCVD
4) individuals ages 40-75 years without known clinical ASCVD or diabetes with LDL-C 70-189 mg/dl and estimated 10-year ASCVD risk >7.5%.
(all high intensity statin DESPITE baseline LDL levels)

Moderate-intensity statin therapy should be used when high intensity is contraindicated, when characteristics predisposing to statin-associated adverse effects are present, and for patients with ASCVD who are ≥75 years of age

Question 8

Saxaglipin

Answer 8

inc’d risk of HF hospitalization

Question 9

Niacin

Answer 9

increases HDL but does not improve survival or decrease CV events

Question 10

Rheumatic fever and carditis

Answer 10

secondary prevention - abx

Question 11

Athletic screening

Answer 11

No indication for routine ECG in otherwise healthy patients - just results in unnecessary additional testing

Question 12

Lifestyle changes

Answer 12

smoking cessation
excercise
diet
weight loss

Question 13

Cardiac Dyspnea

Answer 13

elevated PCWP
low CO
right to left shunting of blood

Question 14

Statins & CK

Answer 14

check baseline at beginning

don’t check again unless muscular sx

Question 15

Primary HTN

Answer 15

most have this

2nd testing for resistant HTN, HTN at young age, new HTN at older age

Question 16

Tx for BP

Answer 16

> 20/10 (>160/100) above goal (usually <140/90) then start with TWO drugs

1) ACE/ARB (not in AA first)
2) dihydropine CCB ie norvasc (AA)
3) thiazide or thiazide like diuretic (AA)

Question 17

Dihydropyradine CCB

Answer 17

amlopidine
feldopine
nifedpine

Question 18

Non-dihydropyradine CCB

Answer 18

Verapamil
Diltiazem
Cardizem

Question 19

Combination anti lipid tx

Answer 19

Do not combine statin with gemfibrozil

Question 20

Young patients with HTN

Answer 20

Pt with family Hx HTN and elevated K+
-check renin/aldo - rule out hyperaldosteroneism
Pt with BP diff in upper and LE
-r/o coarct with MRA/CTA aorta
Pt with h/a, flushing, palpitatiosn
-check serum catecholamines r/o Pheo

Question 21

Preop for vascular surgery (aortic)

Answer 21

Do not excercise if claudication
Pharm nuc
No pharm if wheezing -> use dob stress echo
Adensoine - A2A rct
Brochospasm - A2B/A3 rct

Question 22

Antioxidants

Answer 22

do not benefit secondary prevention ACS

Question 23

Diet post MI

Answer 23

reduce saturated and transfatty acids (<7% sat fat)

Chol <200mg./day

Question 24

TG>500

Answer 24

start with Fenofibrate or niacin until TG<500 and LDL can be calculated then recheck LDL and start statin if needed

Question 25

reduce mortality in ACS and prior CV event patients

Answer 25

Influenza vaccine

BB(post 3 years)/Aldo ant only with reduced EF

Question 26

Screen for secondary HTN causes

Answer 26

1) Young <25 or old >60 at first HTN
2) abrupt onset HTN
3) HTN crisis episodes
4) Sudden worsening of BP control

Question 27

Ambulatory BP monitoring

Answer 27

Can detect fluctuations in BP at home

Sleep non-dipping BP

Question 28

White coat HTN

Answer 28

intermediate risk of CV events between normal and elevated BP

Question 29

Pt with no clinical ASCVD and risk of MACE <7.5% and NO DM/PAD/AAA

Answer 29

No indication for statins

Question 30

10 year pooled cohort ASCVD risk equation

Answer 30

more diverse cohort including AA

broader endpoint death from MI, CVA (fatal/nonfatal), CAD

Question 31

Carotid intimal thickness

Answer 31

NOT indicated for risk assessment of ASCVD

Question 32

Metabolic syndrome

Answer 32

3 or more

1) BP>130/85
2) Fasting glucose >100
3) Waist >40 M, >35 F
4) HDL<40 M <50 F
5) TG>150

Question 33

Prognostic factors stress test

Answer 33

Poor exercise capacity - best predictor of cardiac death

Perfusion abn predict ischemic events not death

Question 34

Prevalanece HF

Answer 34

post age 40 - 1:5 adults (framingham)