NR667 CEA Module notes
Metabolic syndrome - CORRECT ANS: > Insulin-resistance syndrome and Syndrome X.
> Higher need for type II DM and CVD
> Includes three of the following traits
- Male waist circumference > 40
- Female waist circumference > 35
- HTN, BP > 130/8-
- Triglycerides > 150
- HDL < 40 males, < 50 females
- Hyperglycemia, Fasting glucose > 100 mg/dl.
Cardiovascular anatomy and flow complications - CORRECT ANS: > Location
- Central anterior chest
- RV is anteriorly located
- LV is posteriorly located
> 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.
> 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 - CORRECT ANS: >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 "Sart CORRECT ANS:"
- 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 - CORRECT ANS: >HFrEF (Less than 40%)
> HFpEF (Higher than 40%)
> Systolic heart failure: inability for myocardium to effectively contract.
> Diastolic heart failure: inability to myocardium to effectively relax.
> 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.
> Classic symptoms: SOB, Fatigue, exertional dyspnea, dependent and pulmonary edema, low activity
tolerance, abdominal bloating, orthopnea.
> Causes: ischemic heart disease, valve disease, MI, cardiomyopathy.
,> Treatment: ACE/ARB, ARB/ARNI, BB, Diuretics, nitrates plus hydralazine, Fluid and salt restriction, daily
weights.
Lipid management - CORRECT ANS: >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"
Valve disease and aneurysms - CORRECT ANS: > Aortic stenosis: Narrowing of outflow to aortic root
through aortic valve due to calcification. Symptoms tend to mirror CAD with addition of syncope/near
syncope.
> Aortic Regurgitation/Insufficiency: instability for aortic valve to appropriately close. Commonly due to
aortic root dilation or endocarditis/infection. A direct contraindication for IABP use (common board
exam question).
>Mitral stenosis: Narrowing of inflow into LV through the mitral valve due to calcification.
> Mitral regurgitation/Insufficiency: instability for mitral valve leaflets to close. Commonly due to mitral
root dilation from an MI, CHF, induced LV dilation, papillary muscle rupture, endocarditis.
> Identifying Murmurs (left sternal border, 2nd intercoastal).
- Aortic stenosis: swishing, systole, tends to radiate to neck.
, - Mitral stenosis- low-frequency, diastole, tends to radiate to lateral chest.
- Mitral regurgitation: systole,
- Aortic regurgitation, Diastole
>Aortic layers
- Tunica externa
- Tunica media
- Tunica intima
>Aneurysm
- Stanford A (Ascending before the left subclavian): requires surgery (risk of dissecting coronary
ostia/aortic valve).
- Stanford B (descending after the left subclavian): typically treated with endovascular grafting if
anything at all.
- Presentation: asymptomatic, ruptured: classic triad of acute abdominal pain, abdominal distention, and
hemodynamic instability, pulsable mass on abdomen, tearing feeling in back.
- Congenital concerns: marfan's syndrome, Ehlers's-Danlos syndrome, Bicuspid aortic valve commonly
found.
- Other causes: atherosclerosis, vasculitis, uncontrolled HTN. Tobacco use.
- Supportive management: avoid heavy lifting, BP control, avoidance of fluroquinolone antibiotics =
weakening vascular tissue.
DVT/PE Management - CORRECT ANS: > PE
- Saddle emboli commonly require surgery. (will see evidence of right heart strain, S1Q3T3, TR on 2D
echo, enlarged RV.
- Subsegmental not typically requiring emergent surgery (commonly treated with tPA and/or IV
anticoagulation through a direct PA catheter. May use ultrasound-assisted technology (EKOs).
- Provoked vs. Unprovoked.
Metabolic syndrome - CORRECT ANS: > Insulin-resistance syndrome and Syndrome X.
> Higher need for type II DM and CVD
> Includes three of the following traits
- Male waist circumference > 40
- Female waist circumference > 35
- HTN, BP > 130/8-
- Triglycerides > 150
- HDL < 40 males, < 50 females
- Hyperglycemia, Fasting glucose > 100 mg/dl.
Cardiovascular anatomy and flow complications - CORRECT ANS: > Location
- Central anterior chest
- RV is anteriorly located
- LV is posteriorly located
> 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.
> 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 - CORRECT ANS: >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 "Sart CORRECT ANS:"
- 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 - CORRECT ANS: >HFrEF (Less than 40%)
> HFpEF (Higher than 40%)
> Systolic heart failure: inability for myocardium to effectively contract.
> Diastolic heart failure: inability to myocardium to effectively relax.
> 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.
> Classic symptoms: SOB, Fatigue, exertional dyspnea, dependent and pulmonary edema, low activity
tolerance, abdominal bloating, orthopnea.
> Causes: ischemic heart disease, valve disease, MI, cardiomyopathy.
,> Treatment: ACE/ARB, ARB/ARNI, BB, Diuretics, nitrates plus hydralazine, Fluid and salt restriction, daily
weights.
Lipid management - CORRECT ANS: >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"
Valve disease and aneurysms - CORRECT ANS: > Aortic stenosis: Narrowing of outflow to aortic root
through aortic valve due to calcification. Symptoms tend to mirror CAD with addition of syncope/near
syncope.
> Aortic Regurgitation/Insufficiency: instability for aortic valve to appropriately close. Commonly due to
aortic root dilation or endocarditis/infection. A direct contraindication for IABP use (common board
exam question).
>Mitral stenosis: Narrowing of inflow into LV through the mitral valve due to calcification.
> Mitral regurgitation/Insufficiency: instability for mitral valve leaflets to close. Commonly due to mitral
root dilation from an MI, CHF, induced LV dilation, papillary muscle rupture, endocarditis.
> Identifying Murmurs (left sternal border, 2nd intercoastal).
- Aortic stenosis: swishing, systole, tends to radiate to neck.
, - Mitral stenosis- low-frequency, diastole, tends to radiate to lateral chest.
- Mitral regurgitation: systole,
- Aortic regurgitation, Diastole
>Aortic layers
- Tunica externa
- Tunica media
- Tunica intima
>Aneurysm
- Stanford A (Ascending before the left subclavian): requires surgery (risk of dissecting coronary
ostia/aortic valve).
- Stanford B (descending after the left subclavian): typically treated with endovascular grafting if
anything at all.
- Presentation: asymptomatic, ruptured: classic triad of acute abdominal pain, abdominal distention, and
hemodynamic instability, pulsable mass on abdomen, tearing feeling in back.
- Congenital concerns: marfan's syndrome, Ehlers's-Danlos syndrome, Bicuspid aortic valve commonly
found.
- Other causes: atherosclerosis, vasculitis, uncontrolled HTN. Tobacco use.
- Supportive management: avoid heavy lifting, BP control, avoidance of fluroquinolone antibiotics =
weakening vascular tissue.
DVT/PE Management - CORRECT ANS: > PE
- Saddle emboli commonly require surgery. (will see evidence of right heart strain, S1Q3T3, TR on 2D
echo, enlarged RV.
- Subsegmental not typically requiring emergent surgery (commonly treated with tPA and/or IV
anticoagulation through a direct PA catheter. May use ultrasound-assisted technology (EKOs).
- Provoked vs. Unprovoked.
