NR667 CEA Module notes || || || ||
questions with answers || || ||
Cardiovascular anatomy and flow complications || || || ||
Ø Location
||
- Central anterior chest
|| || ||
- RV is anteriorly located
|| || || ||
- LV is posteriorly located
|| || || ||
Ø Flow of blood in the body
|| || || || || ||
- Lungs > pulmonary veins > left atrium > left ventricle
|| || || || || || || || || || ||
> aorta > body tissues > vena cava > right atrium >
|| || || || || || || || || || || ||
right ventricle > pulmonary arteries > lungs.
|| || || || || ||
Ø Blood flow complications
|| || ||
- Contractility: EF, CAD, LVH, Cardiomyopathy
|| || || || ||
- Preload: Central fluid volume status
|| || || || ||
- Afterload: Arterial backpressure on outflow (Chronic
|| || || || || || ||
hypertension). (**RAAS system typically manages this). || || || || ||
Hypertension
Ø JNC8
||
,- Defined as 140/90
|| || ||
- Secondary HTN: Up flow issue going up to kidney, ex:
|| || || || || || || || || || ||
renal stenosis. ||
- Age > 60 or < 60 years. (>60 = 150/90).
|| || || || || || || || || ||
- DM and CKD: ACE/ARBs (nephro protective).
|| || || || || ||
- Non-black vs. Black: Calcium channel blocker for
|| || || || || || || ||
African Ascent. ||
- General starting place: Thiazides/ACE/ARBs.
|| || || ||
- ACE/ARBS: “Prils” and “Sartans”
|| || || ||
- Beta Blockers: “olol” not on JNC8 guidelines, history of
|| || || || || || || || || ||
cardiac disease, reduce HR. Carvedilol is a dual
|| || || || || || ||
alpha/beta, great for Heart failure.
|| || || || ||
- CCB: Dihydropyrines and Non-Dihydropyrines.
|| || || || ||
Dihydropyrines work more peripherally (amlodipine, || || || || ||
etc). Non-Dihydropyrines work more on heart (Verapamil
|| || || || || ||
,and diltiazem). Common ASE: Constipation and
|| || || || || || ||
peripheral edema. ||
- Diuretics: Thiazides, Loops. Thiazides are less potent.
|| || || || || || || ||
Thiazide= Low electrolytes, Higher calcium. Loops-
|| || || || || ||
lowers everything. Potassium-sparing diuretics (Increase
|| || || || ||
potassium, lowers sodium). || ||
Heart failure ||
Ø HFrEF (Less than 40%)
|| || || ||
Ø HFpEF (Higher than 40%)
|| || || ||
Ø Systolic heart failure: inability for myocardium to
|| || || || || || || ||
effectively contract. ||
Ø Diastolic heart failure: inability to myocardium to
|| || || || || || || ||
effectively relax. ||
Ø Typical patient: elderly with comorbidities of HTN,
|| || || || || || || ||
DM, Smoking. ||
- Class I: Mild symptoms
|| || || ||
- Class II-III: Symptoms with exertion (II), ADL's cause
|| || || || || || || || ||
symptoms (III) ||
- Class IV: Symptoms severe, likely needs hospitalization.
|| || || || || || ||
, Ø Classic symptoms: SOB, Fatigue, exertional dyspnea,
|| || || || || || ||
dependent and pulmonary edema, low activity tolerance,
|| || || || || || ||
abdominal bloating, orthopnea. || ||
Ø Causes: ischemic heart disease, valve disease, MI,
|| || || || || || || ||
cardiomyopathy.
Ø Treatment: ACE/ARB, ARB/ARNI, BB, Diuretics,
|| || || || || ||
nitrates plus hydralazine, Fluid and salt restriction, daily
|| || || || || || || ||
weights.
Lipid management
||
Ø AVSCD
||
- Statins
||
- Hight-intensity statins: Atorvastatin 40-80mg and
|| || || || || ||
Rovusatan 20-40mg (Don't require being taken at
|| || || || || || ||
bedtime). LDL < 190 || || ||
- Common ASE: Myalgia. Rhabdomyolysis worse case
|| || || || || || ||
scenario.
- Statins, Ezetimibe in conjunction. PC9-Inhibitors
|| || || || || ||
(injectable Q2 weeks). (Cardiology at consult prior to
|| || || || || || || ||
PC9-Inhibitors).
- Familial homozygous hyperlipidemia= PC9-Inhibitors.
|| || || ||
- HDL: "Cleaning agent."
|| || ||
- LDL- "Scrum between glass window in shower"
|| || || || || || ||
questions with answers || || ||
Cardiovascular anatomy and flow complications || || || ||
Ø Location
||
- Central anterior chest
|| || ||
- RV is anteriorly located
|| || || ||
- LV is posteriorly located
|| || || ||
Ø Flow of blood in the body
|| || || || || ||
- Lungs > pulmonary veins > left atrium > left ventricle
|| || || || || || || || || || ||
> aorta > body tissues > vena cava > right atrium >
|| || || || || || || || || || || ||
right ventricle > pulmonary arteries > lungs.
|| || || || || ||
Ø Blood flow complications
|| || ||
- Contractility: EF, CAD, LVH, Cardiomyopathy
|| || || || ||
- Preload: Central fluid volume status
|| || || || ||
- Afterload: Arterial backpressure on outflow (Chronic
|| || || || || || ||
hypertension). (**RAAS system typically manages this). || || || || ||
Hypertension
Ø JNC8
||
,- Defined as 140/90
|| || ||
- Secondary HTN: Up flow issue going up to kidney, ex:
|| || || || || || || || || || ||
renal stenosis. ||
- Age > 60 or < 60 years. (>60 = 150/90).
|| || || || || || || || || ||
- DM and CKD: ACE/ARBs (nephro protective).
|| || || || || ||
- Non-black vs. Black: Calcium channel blocker for
|| || || || || || || ||
African Ascent. ||
- General starting place: Thiazides/ACE/ARBs.
|| || || ||
- ACE/ARBS: “Prils” and “Sartans”
|| || || ||
- Beta Blockers: “olol” not on JNC8 guidelines, history of
|| || || || || || || || || ||
cardiac disease, reduce HR. Carvedilol is a dual
|| || || || || || ||
alpha/beta, great for Heart failure.
|| || || || ||
- CCB: Dihydropyrines and Non-Dihydropyrines.
|| || || || ||
Dihydropyrines work more peripherally (amlodipine, || || || || ||
etc). Non-Dihydropyrines work more on heart (Verapamil
|| || || || || ||
,and diltiazem). Common ASE: Constipation and
|| || || || || || ||
peripheral edema. ||
- Diuretics: Thiazides, Loops. Thiazides are less potent.
|| || || || || || || ||
Thiazide= Low electrolytes, Higher calcium. Loops-
|| || || || || ||
lowers everything. Potassium-sparing diuretics (Increase
|| || || || ||
potassium, lowers sodium). || ||
Heart failure ||
Ø HFrEF (Less than 40%)
|| || || ||
Ø HFpEF (Higher than 40%)
|| || || ||
Ø Systolic heart failure: inability for myocardium to
|| || || || || || || ||
effectively contract. ||
Ø Diastolic heart failure: inability to myocardium to
|| || || || || || || ||
effectively relax. ||
Ø Typical patient: elderly with comorbidities of HTN,
|| || || || || || || ||
DM, Smoking. ||
- Class I: Mild symptoms
|| || || ||
- Class II-III: Symptoms with exertion (II), ADL's cause
|| || || || || || || || ||
symptoms (III) ||
- Class IV: Symptoms severe, likely needs hospitalization.
|| || || || || || ||
, Ø Classic symptoms: SOB, Fatigue, exertional dyspnea,
|| || || || || || ||
dependent and pulmonary edema, low activity tolerance,
|| || || || || || ||
abdominal bloating, orthopnea. || ||
Ø Causes: ischemic heart disease, valve disease, MI,
|| || || || || || || ||
cardiomyopathy.
Ø Treatment: ACE/ARB, ARB/ARNI, BB, Diuretics,
|| || || || || ||
nitrates plus hydralazine, Fluid and salt restriction, daily
|| || || || || || || ||
weights.
Lipid management
||
Ø AVSCD
||
- Statins
||
- Hight-intensity statins: Atorvastatin 40-80mg and
|| || || || || ||
Rovusatan 20-40mg (Don't require being taken at
|| || || || || || ||
bedtime). LDL < 190 || || ||
- Common ASE: Myalgia. Rhabdomyolysis worse case
|| || || || || || ||
scenario.
- Statins, Ezetimibe in conjunction. PC9-Inhibitors
|| || || || || ||
(injectable Q2 weeks). (Cardiology at consult prior to
|| || || || || || || ||
PC9-Inhibitors).
- Familial homozygous hyperlipidemia= PC9-Inhibitors.
|| || || ||
- HDL: "Cleaning agent."
|| || ||
- LDL- "Scrum between glass window in shower"
|| || || || || || ||
