Notes in cardiac testing

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Published	09/08/2024	atherosclerosis:begins with an {{c1::injury}} or {{c1::inflammation}} to a blood vessel. Monocytes bind the endothelium, cross into subendot…
Published	09/08/2024	•Lipoprotein = {{c1::Lipid complex}} + {{c1::apolipoproteins}}
Published	09/08/2024	•{{c1::Chylomicrons:}} very large, mostly {{c2::triglycerides}}.  Found in the {{c2::exogenous}} pathway – absorption of lipids, cholesterol from…
Published	09/08/2024	•{{c1::VLDL}}: larger than triglycerides but smaller than chylomicrons.  Found in the {{c2::endogenous}} pathway - formed by and secreted fr…
Published	09/08/2024	IDL:  {{c1::intermediate density lipoprotein. }}
Published	09/08/2024	•LDL:  low density lipoprotein.  {{c1::Low}} triglycerides, {{c1::mostly}} cholesterol.
Published	09/08/2024	•Lipoprotein a (Lpa):  formed from {{c1::LDL’s}}.  Atherogenic (promotes atherosclerosis)
Published	09/08/2024	•HDL:  high density lipoprotein.  {{c1::Very little}} triglycerides, {{c1::less}} chol (15-25%), {{c1::mostly}} protein
Published	09/08/2024	Apolipoproteins: •apoA – found on {{c1::HDL}} particles  •apoB – found on {{c1::non-HDL}} particles {{c1::(LDL, IDL, VLDL)}} •apoC – found with {…
Published	09/08/2024	lipid screening recommendations:screen and treat men {{c1::greater or equal to 35 years}} and women {{c1::greater or equal to 45 years}} of age for li…
Published	09/08/2024	AAP recommends offering lipid screening to adolescents at least {{c1::once}}
Published	09/08/2024	HDL should be greater or equal to {{c1::40 }}
Published	09/08/2024	LDL should be less than or equal to {{c1::130}} but should be < {{c1::100}} if other comorbidities present, such as CAD, PAD, HF-If DM, goal is {{c…
Published	09/08/2024	total cholesterol should be {{c1::155-199}}
Published	09/08/2024	If triglycerides are really high, pt could have {{c1::pancreatitis}} If its really high it will look like {{c1::foam}}
Published	09/08/2024	•{{c1::LDL/HDL ratio}} Helps determine risk for ASCV
Published	09/08/2024	•{{c1::Cholesterol/HDL}} ratio Helps further risk stratify for ASCVD
Published	09/08/2024	•{{c1::Non-HDL}} - Helps better assess risk by looking at all "bad" cholesterol
Published	09/08/2024	•{{c1::VLDL}}  - Carries triglycerides
Published	09/08/2024	ASCVD Risk Calculator includes (11) {{c1::age, sex, race, total cholesterol, HDL, LDL, HX of DM, smoker, hypertensive medication, statin medication, a…
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Published	09/08/2024	Coronary calcium scoring is an assessment that uses a {{c1::CT scan}} to detect {{c1::calcium}} in coronary arteries and is good for pts with an {{c1:…
Published	09/08/2024	CAC ct scan {{c1::does not}} use contrast
Published	09/08/2024	A coronary calcium score of 0 does not let you "off the hook", just means that there isn't {{c1::calcified coronary plaques}}. If high risk, should st…
Published	09/08/2024	if the CAC score is greater than {{c1::0}}, should consider statin
Published	09/08/2024	high levels of Lp(a) is associated with increased risk for (2){{c1::atherosclerotic CAD, aortic stenosis}}
Published	09/08/2024	Lp(a) 80-90% genetically determined, remains stable despite lifestyle changes•Consider testing in patients with a first-degree relative w/ (2) {{c1::p…
Published	09/08/2024	Based on the available data, the authors recommend initiating a moderate- to high-intensity statin therapy in adults aged 40-75 years with a 10-year A…
Published	09/08/2024	Carotid Dopplers are ultrasound imaging to assess blood flow in the carotid arteries to determine if there is {{c1::flow limiting plaque  }}
Published	09/08/2024	•USPSTF Grade {{c1::D}} recommendation for carotid dopplers for asymptomatic patients: {{c1::NOT recommended}}
Published	09/08/2024	a carotid doppler would be indicated for pts that are symptomatic with (3) {{c1::TIAs, stroke like symptoms, syncope}}
Published	09/08/2024	abnormal blood flow on a carotid doppler would show {{c1::restriction}} and blood flow going {{c1::backwards }}
Published	09/08/2024	Ankle Brachial Index (ABI) is a {{c1::sensitive}} and {{c1::specific}} measurement for diagnosing {{c2::PAD}}.Can predict mortality and major adverse …
Published	09/08/2024	•ABI = systolic pressure of the {{c1::ankle}} / systolic pressure of the {{c1::arm}}
Published	09/08/2024	(3) {{c1::atherosclerosis and DM and a FHx of PAD}} increase pts risk of PAD
Published	09/08/2024	CK-MB•More specific to {{c1::cardiac muscle}} than CK alone •Should be used in addition to {{c1::symptoms (chest pain, etc.)}} •Not as useful when {{c…
Published	09/08/2024	Troponin•Mismatch between {{c1::oxygen supply}} and {{c1::demand}} leads to {{c2::cell necrosis}} and {{c2::death}}, troponin release•Almost {{c3::100…
Published	09/08/2024	Hs-Troponins •Very sensitive and {{c1::precise}} •May allow {{c1::earlier}} diagnosis of AMI and catch patients previously missed by traditional …
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Published	09/08/2024	acute iscemia pathway includes two strategies:early invasive strategy includes {{c1::immediate or 12-24 hr angiography}}andearly conservative strategy…
Published	09/08/2024	stress testing with exercise a pt must be able to (2) {{c1::exercise and get to 85% of target HR }}
Published	09/08/2024	the two pharmacological approaches for stress testing are {{c1::vasodilator}} and {{c1::dobutamine}}
Published	09/08/2024	•{{c1::Vasodilator:}} dipyridamole, adenosine •"Steals" from areas of atherosclerosis
Published	09/08/2024	•{{c1::Dobutamine}} •Increases oxygen demand
Published	09/08/2024	EKG stress test•Detect signs of {{c1::ischemia}} on EKG  •{{c1::Low to intermediate}} risk for CAD •Not able to use in patients with {{c1::baseli…
Published	09/08/2024	Echo stress test•Evaluate for {{c1::wall motion}} abnormalities •Good for patients with {{c1::LBBB}} •{{c2::Intermediate}} risk for CAD •Imaging may b…
Published	09/08/2024	Myocardial Perfusion Imaging stress test•{{c1::Nuclear}} medicine imaging •{{c1::Intermediate-high}} risk for CAD •Good for patients with {{c1::baseli…
Published	09/08/2024	on a MPI, the top is {{c1::stress}} the bottom row is {{c1::rest}} and  you are looking for {{c1::differences between them}}
Published	09/08/2024	indications for a Transthoracic Echocardiography are mvp kick aas: •{{c1::Murmurs •Valvular disease •Prosthetic valve assessment •Known/suspected…
Published	09/08/2024	Transthoracic Echocardiography•Images may be limited due to {{c1::body habitus, "poor windows"}} •First line testing modality as {{c1::noninvasiv…
Published	09/08/2024	Transesophageal Echocardiography•{{c1::Invasive}} evaluation  •Used when more data is needed than cannot be obtained with TTE alone •Indications:…
Published	09/08/2024	Brain Natriuretic Peptides•Polypeptide stimulated by {{c1::ventricular volume expansion}} and {{c1::pressure overload}}.  •In…
Published	09/08/2024	NT-pro BNP•More "{{c1::stable}}" form of BNP  •Not affected by {{c2::neprilysin inhibition (ARNi)}} •About {{c3::3x}} higher than …
Published	09/08/2024	BNP•Should be used {{c1::thoughtfully}} and in addition to clinical exam! •Helpful when diagnosis is {{c1::uncertain}} •Trend and establish a {{c…
Published	09/08/2024	Indications for TTE are for pts with {{c1::suspected or newly diadnosed HF}} and pts with {{c1::HF who had a signficant clinical change }}
Published	09/08/2024	Transthoracic echocardiography (TTE)A noninvasive ultrasonographic examination of the heart in which a transducer is pla…
Published	09/08/2024	TTE is recommended for initial evaluation of {{c1::pathological murmurs }} and is used  to assess {{c1::valvular functio…
Published	09/08/2024	•What diagnostic testing are needed for monitoring and prevention of future ASCVD events{{c1::lipid panel}}{{c1::CMP and U/A for liver function, elect…
Published	09/08/2024	Heart Failure is diagnosed by symptoms and/or signs of HF caused by a {{c1::structural and/or functional}} {{c1::cardiac abnormality}} and corroborate…
Published	09/08/2024	Labs and diagnostics used for preventative cardiology include:lipids: 2 {{c1::lipid profiles and Lp(a)}}screening: 3 {{c1::Coronary calcium scoring, c…
Published	09/08/2024	cardiac biomarkers and assessment of MIs includes:miomarkers: {{c1::troponin, CK}}{{c1::stress testing, ekg, echo, MPI (myocardial perfusion imaging)}…
Published	09/08/2024	labs and diagnostics for heart failure include:3 {{c1::BNP, Transthoracic echocardiography, and cardiac MRI }}
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