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Cardiovascular and Cerebrovascular Events

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morauch630's version from 2017-12-11 04:02

Section

Question Answer
Cardiovascular events includeAngina and MI
T/F Risk of developing ischemic heart disease differs by region of the worldT
Regions if the world with low ratesJapan and France
Regions if the world with high ratesFinland, Northern Ireland, Scotland, and South Africa
T/F Numbers of vessels obstructed is a predictor of survivabilityF. Mortality
Which vessel if obstructed has poor prognosisLAD
Angina pathophysiologyatherosclerosis, increased O2 demand, decreased O2 supply, catecholamine release
Patho for atherosclerosisFatty streak (LDL), smooth muscle cells, calcification, thrombus
Patho for increased O2 demandexercise, stress, normal fluctuation in HR and BP
Patho for decreased O2 supplyVasospasm, Platelet plugging, Thrombus
Patho for catecholamine releaseReleased in response to stress, Leads to increased HR, BP, force of contraction, This leads to increased oxygen demand
Atherothrombotic Vascular Disease A Generalized and Progressive Process
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Angina

Question Answer
Define anginaMyocardial ischemia that occurs when oxygen demand outstrips oxygen supply. Reversible . Lasts from 0.5-30 minutes
TypesStable, unstable, Varient (prinzmetals), silent ischemia
Stable anginaReproducible symptom pattern. No change in frequency, duration, or precipitating factors in last 2 months
Unstable anginaChange in pattern of ischemia. New onset, onset with less exertion, or pain at rest. Patient should be admitted
Variant (Prinzmetal’s) anginaCoronary artery spasm. Rare
Silent ischemiaAsymptomatic episodes detected by ECG or other diagnostic methods
Characteristics of anginaprecipitating factors, quality, radiation, location
Precipitating Factors (5)Relationship to exercise. Cold environment. Walking against the wind. Walking after a large meal. Fright, anger
Quality (5)Sensation of pressure or heavy weight on chest, Burning sensation, Feeling of tightness, Shortness of breath, Visceral quality (deep, heavy, squeezing, aching)‏
Radiation (4)Medial aspect of left arm, Left shoulder, Jaw, Occasionally right arm
Location (4)Sternum, Can be anywhere between epigastrium and pharynx, May be limited to left arm and shoulder, Lower cervical or thoracic spine, Left interscapular or suprascapular area
Differential dx (7)Esophageal reflux, Peptic ulcer, Biliary disease, Cervical disc disease, Hyperventilation , Musculoskeletal pain, Pulmonary
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Special Populations

Question Answer
Which comorbidities would you tx soonerCigarette smoker, DM, HTN (BP ≥ 140/90 mmHg or on antihypertensive medication), Family history of premature CHD (CHD in male first degree relative < 55 years; CHD in female first degree relative < 65 years). Age (men ≥ 45 years; women ≥ 55 years)
0-1 Risk FactorLDL Goal < 160 mg/dL, LDL level to initiate TLC ≥ 160 mg/dL, LDL to consider drug therapy ≥ 190 mg/dL
2+ Risk FactorsLDL Goal < 130 mg/dL, LDL level to initiate TLC ≥ 130 mg/dL, LDL to consider drug therapy ≥ 130 mg/dL if 10-yr risk > 10%, ≥160 if 10-yr risk <10%
CHD or CHD Risk EquivalentsLDL Goal < 100 mg/dL, LDL level to initiate TLC ≥ 100 mg/dL, LDL to consider drug therapy ≥ 100 mg/dL
CHD Risk EquivalentsNoncoronary vascular disease, Peripheral vascular disease, Carotid disease, Abdominal aortic aneurysm, Type 2 Diabetes Mellitus, 10 – year CHD risk > 20% , Based on Framingham tables
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Treatment

Question Answer
Modification of risk factorsDecrease weight, Stop smoking, Increase activity, Normalize blood pressure, Normalize blood lipid levels, Increase oxygen supply
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LDL Cholesterol

Question Answer
ATP 3 classifications for LDL cholesterolPrimary target of therapy
LDL Optimal cholesterol lvl<100
LDL Near optimal/above optimal100 – 129
LDL Borderline high130 – 159
LDL High160 – 189
LDL Very High≥ 190
Risk Factors That Modify LDL GoalsCigarette smoking. Diabetes. Hypertension (BP ≥ 140/90 mmHg or on antihypertensive medication). Family history of premature CHD (CHD in male first degree relative < 55 years; CHD in female first degree relative < 65 years). Age (men ≥ 45 years; women ≥ 55 years)
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Total Cholesterol

Question Answer
Total cholesterol Desirable lvl< 200
Total cholesterol Borderline high200 – 239
Total cholesterol High≥ 240
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HDL Cholesterol
Question Answer
HDL Low< 40
HDL High≥ 60
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