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160 Cards in this Set
- Front
- Back
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What are guidlines for hypertension diagnosis?
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Normal: > 120 > 80
Prehypertensive: 120-139, 80-89 Stage I hypertension: 140-159, 90-99 Stage 2 hypertension: > 160, > 100 |
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What are greatest risk groups for hypertension?
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Black and hispanic more than white, more men than women
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List complication of uncontrolled hypertension
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Kidney Disease and failure: hypertension is the second most common cause of kidney failure (after diabetes)
1.Heart Disease 2.Myocardial Infarction 3.Left ventricular hypertrophy 4.Cerebral Hemorrhage 5.Eye complications: Retinal microaneurysms |
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When to initiate hypertensive drugs?
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When pt is 20mm above systolic goal and 10mm above diastolic goal. Usually need 2 meds at lower doses rather than one at a higher dose to lower B/P
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What antihypertensive drugs should be used together for uncomplicated hypertension?
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ACEI or
ARB plus a diuretic, and an ACEI or ARB plus a calcium channel blocker |
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What is resistant hypertension?
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as consistent blood
pressures (BP) over 140/90 mm Hg while using three or more drugs at full doses, including a diuretic. |
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What are risks for resistant hypertension?
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older age, high baseline BP, obesity, excess salt
intake, chronic kidney disease (CKD), diabetes, left ventricular hypertrophy (LVH), female gender, African-American race, and residing in the Southeast United States. |
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What are some drugs that can increase B/P?
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stimulants, oral contraceptives, cyclosporine,
erythropoietin, and corticosteroids can cause increases in blood pressure. OTC or herbal medications such as decongestants, weight loss agents, natural licorice, ephedra, and ma huang |
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What is new with JNC 7?
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For persons over age 50, SBP is a more important than DBP as CVD risk factor. Starting at 115/75 mmHg, CVD risk doubles with each increment of
20/10 mmHg throughout the BP range.Those with SBP 120–139 mmHg or DBP 80–89 mmHg should be considered prehypertensive who require health-promoting lifestyle modifications to prevent CVD.Thiazide-type diuretics should be initial drug therapy for most, either alone or combined with other drug classes.Most patients will require two or more antihypertensive drugs to achieve goal BP.If BP is >20/10 mmHg above goal, initiate therapy with two agents, one usually should be a thiazide-type diuretic. |
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What are benefits of lowering B/P?
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Stroke incidence lowered 35–40%
Myocardial infarction lowered 20–25% Heart failure lowered 50% |
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How to test B/P accurately?
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let pt sit for 5 min beforehand in a chair, take twice and in both arms, use appropriate sized cuff, can use ambulatory readings for "white coat" syndome, B/P should decrease 10-20% at night
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What are identifiable risk factors for CVD?
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What are identifiable causes of hypertension?
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What organs can be damaged d/t hypertension?
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What routine lab tests are used for hypertension diagnosis?
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What are some lifestyle changes that can be made to lower B/P?
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weigth reduction, DASH diet, lower salt intake, increase physical activity, moderation in alcohol consumption
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How to treat stage I hypertension? SBP 140–159 or DBP 90–99 mmHg)
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Thiazide-type diuretics for most. May consider ACEI, ARB, BB, CCB, or combination.
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How to treat stage 2 hypertension? SBP >160 or DBP >100 mmHg)
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2-drug combination for most (usually thiazide-type diuretic and ACEI, or ARB, or BB, or CCB)
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What labs need to be monitored if on B/P meds?
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Serum potassium and creatinine, once B/P stable pt f/u q3-6 months
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What special situations seen in B/P should be given special consideration?
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Minority populations
• Obesity and the metabolic syndrome • Left ventricular hypertrophy • Peripheral arterial disease • Hypertension in older persons • Postural hypotension • Dementia • Hypertension in women • Hypertension in children and adolescents • Hypertension urgencies and emergencies |
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What B/P meds cannot be used in pregnancy?
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ACEIs and ARBs are contraindicated in pregnant women or those likely to become pregnant.Methyldopa, BBs, and vasodilators, preferred for the safety of the fetus.
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When shoudl beta blockers not be used?
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patients with asthma, reactive airways disease, or second-or third-degree heart block
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When should thiazide diuretics not be used?
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used cautiously in gout or a history of significant hyponatremia.
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Risk factors for CV D
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elevated b/p, metabolic syndrome, renal dysfunction, family hx of CVD, age, sex, smoker, diabetes, dyslipedemia,
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Hypertension is a process of aging? t or f
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true, Systolic pressure increases with age & diastolic decreases with age - look at systolic after age 50
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65 yo with B/P 130-139/85-89 then 50% will be hypertensive in 4 years
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65 yo with B/P of 120-129/80-84 then 26% will be hypertensive in 4 years
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Diabetic and renal patients need lower B/P than other patients. T or F
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True need to regulate B/P lower than 130/80 rather than 140/90
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Name barriers to achieving B/P goals?
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culruarl norms, insufficient attn to health ed by practitioner, lack of reimbursement for health ed, lack of access for physical activity, larger servings in restauratns, lack of healthy food choices, lack of exercise in schools, increase sodium in foods, higher costs to foods low in sodium
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Homocystine Cardiac marker
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amino acid occurs natural in body, increased levels 15-100 umol/L, Hyperhoocysteine caused by genetic defects, smoking, fibrate and niacin meds adn nutritional defects of vit. B1, B6 & B12
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What happen when have hyperhomocystine?
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Combines with LDL to produce bad cells, increases prothombotic properienties, and produces free radicals
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How to treat hyperhomocystine?
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give folic acid 1mg/day - no evidence to support helps lower risk for CVD
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C-Reactive Protien marker
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shows evidence of CVD, but does not cause CVD
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How to treat if C-reactive protien (CRP) high?
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diet, statins, beta blockers, glitazones, - ASA and hormones can increase CRP
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When to test for CRP?
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If low cardiac risk (Framingham) then no test, if intermediate risk then CRP can help predict CV event or stroke - going to treat anyway with intermediate risk
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What is lipoprotien (a)?
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modified form of LDL, similar to plasminogen with helps dissolve clots so it competes with plasminogen adn promotes coagulation, binds iwth macrophages taht form cholesterol deposits in plaques, > 10 mg/dl is high
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When to test for lipoprotien (a)?
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normal lipid panels, but estabilished CVD, family hx, hihg lipid not responding to statins, no treatment to lower this Niaspan has some effect
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Heart failure afflicts 10 out of every 1,000 over age 65
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true
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Burdens of Heart Failure
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congestionve s/s, hospitalizations, dysrhthmias, reduced survival,
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how to treat HF?
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weight reduction, no smoking, avoid alchol, exercise, treat HTN, hyperlipidemia, diabets, arrhthrymiass, anticouagulation sodium restriction, daily weights, flu vaccine every year
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What causes heart failure?
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ischemic heart disease, HTN, idopathis cardiomyopathy, infections, toxins, valvular disease, prolonged arrhthmias
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What stage of heart failure will you see most in office?
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Stage C: structional heart disease with prior/current sy/s of HF, reduced LVEF
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What drugs to use to treat Stage C HF?
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diuretics, ACE inhibitors, beta blockers, Some pt need: dig, aldosterone inhibitors, ARB, hydralizine, pacemakers, implanted defib
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What are s/s of with left ventricular heart failure?
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dyspnea with exerction, paroxysmal noctorunal sysnpea, tachycardia, cough, hemoptsis. Exam: basilar rales, pulmonary edema, s3 gallop, pleural effusion, cheyne stokes resp
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What are s/s of right ventricular heart failure?
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adb pain, anorexia, nausea, bloating, swelling. Physical: periphearl edem, jugular venous distention, abd jugular reflux, heptomegaly
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What are normal body neurohormonal responses to impaired cardiace performance?
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1)salt and ater retention - augemnt preload, but causes pulmonary congestion 2) Vasoconstriction - maintians B/P for perfusion, but exacerbates pump dysfunction, 3) sympathotic stimulation - increased HR & ejection - increase energy expenditure and tires out heart
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S/S of Heart Failure - FACES
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F- fatigue A - Activities limited C - chest congestion E - Edmea or ankle swelling (men can retain fluid in abd - ask how clothes fittin) S - SOB
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What to order for HF?
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EKG, labs, CXR, echo
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HOw many classes of HF are there?
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4 - class IV worst bed ridden or wheelchair bound
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How do ACe inhibitors help in HF?
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dilate bld vessels, increaes bld flow
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How do Beta Blockers help in HF?
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help strenghen heart's pumping ability, block the response to neurohormanl substances. slow down heart
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How dose aldosterone inhibitors help in HF?
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primarly used in chronic class 3 HF to supress the renin-angiotensin-aldosterone system
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What beta blockers are used with HF? (use with hydrothiazide diuretics)
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CArvedilol (Coreg) initial dose 3.25 targe does 25-50 mg/bid, metoprolol XL initial dose 12.5 target dose 150m/d, Bisoprolol (Zebeta) 1.25-2.5 target 10 mg/d, - start low and double dose q2-3 weks
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What ACE inhibitors work with HF? (All the same in trials)
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Captopril 6.25 TID, max dose TID, enalapril, (do not take at same time at beta blocker)
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What is aldosterone antoagonists?
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potassium sparing diuretic - spironolactone use with Class 4 patients
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What meds help control s/s of HF?
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Diuretics (never used alone with HF) and digoxin
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HOw to dose diuretics?
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do not use high dose - can be dangerous, counteracts with arthritis meds - be careful with renal function
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Why use Digoxin with HF
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reduces s/s of HF, does not improve survival, never use alone use with ACEI or beta blockers
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Should anti-cougulants be used with HF?
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no - evidence that this beneficial
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What to avoid with HF?
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Antiarrhythmic agents, CA channel blockers - nonsteroidal anti-inflammatory (advil, naproxin sodium) can take Tylenol
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What other factors seen with HF?
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Afib, Sleep apnea, importance of exercise - walk 5 mintues a day to start and increase to 30 min
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What should pts with HF do daily?
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weigh themselves daily, ask if any syncope, can be s/s of hidden arrthymia, do not take sudafed Inc B/P
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What class of meds can exacerabate HF and shoudl be avoided?
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Antiarrhytmic agents, CA channel blockers, NSAIDS
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What non-meds are available for HF patients?
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implantable cardiac defibrilators (ICD and CRT/ICD), cardiac resynchronization Therapy pacemakers
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Who is more prone to sudden death with HF?
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Class II people
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What rhythm is often seen with HF?
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A-fib, can do catheter ablation, or amnioterone, need to control rate below 100, find out why in A-fib precipitoating factors: ischemia, sleep apnea, electolyte abnol, thyroid, recent heart surgery, is there need for anti coap therapy/
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What pattern seen with HF
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Sleep Apnea, do you feel rested, snore?
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Goals with HF?
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exercise
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What is survival rate for HF diagnosis?
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5 yr survial rate less than 50% and less than 25 % for 10 yr. refer to cardiologist, older adults 6 yr mortality rate is 80% for men adn 65% for women, incurable and progressive
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What are causes of HF?
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Coronary artery disease, hypertension, and dilated cardiomyopathy, Valvular heart disease
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What is defiinition of HF?
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HF is defined as a clinical syndrome that is characterized by specific symptoms (dyspnea and fatigue) in the medical history and signs (edema, rales) on the physical examination
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How is HF classified?
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depending on the degree of effort needed to elicit symptoms. (class IV), on less-than-ordinary exertion (class III), on ordinary exertion (class II), or only at levels of exertion that would limit normal individuals (class I).
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Who is at risk for HF or Stage A? (no diagnosed heart disease or s/s of heart disease)
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pt with hypertension, atherosclerotic disease, diabetes, obesity, metabolic syndrome or pt using cardiotoxins or with fam hx of CM
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What is treatment for Stage A HF?
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treat high B/P, stop smoking, treat lipid disorders, inc exercise, discourage alcohol or drug, control metabolic syndrome.
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What drugs or therapy are used in Stage A HF?
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ACEI or ARB if high B/P
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Who is in stage B HF? structural risk without s/s of HF
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Pt iwth previous MI, LV remodeling, including LVH and low EF, asymptomatic valvar disease
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What is therapy for Stage B HF?
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All goals under Stage A, Drugs: ACEI or ARB, beta blockers in approp pts.
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What is Stage C HF?
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structural heart disease with prior or current symptoms of HF
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Who is in Stage C HF?
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Pts with know structural heart disease and SOB and fatigue and reduced exercise tolerance
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What is therapy for stage C HF?
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Goals: same as A & B plus salt restriction, Drugs: Diuretics for fluid retention, ACEI, Beta-blockers, Drugs in selected pts: Aldosterone antagonist ARBs, digitalis, hydralazine/nitrates, Devices to use: biventricular pacing, implantable defib
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What is Stage D HF?
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Refractory HF requireing specialized intervention
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Who is in Stage D HF?
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Pts who have marked symptoms at rest despite maximal medical therapy - recurrantly hsopitalized
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What is theraphy for Stage D HF?
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Goals: Approp measures under A- C, Options: decide on end of life care/hospice. Extraordinary options: heart transplant, chonic inotropes, permanent mechanical support, experiemntal surgery or drugs
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What is most common arrhythmia?
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A-fib currently seeni n 10% people over 80
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Dangers of A-Fib?
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syncope, bld clots formed causing TIA or stroke
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How to treat A-fib?
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controversal can either use drugs to control ventricular rate of try to convert A-fib to sinus rhythmn, Can use Ca Channel blockers, kiliazem or verapamil or beta blockers. Can use antiarrhythmias or cardio version. IF stay in A-fib may need to treat with warfarin depednding on risk for stroke
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How to use CHADS2 score with patients in A-Fib
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Does pt have CHF hx (1), HTN (1), age greater than 75 1), Diabetes (1), previous stroke or TIA (2)?
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What is the new drug approved as an anti-coag drug?
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Dabigatran or (Pradaxa) direct inhibitor of thrombin, irreversib le no antidote can use hemodialysis to remove
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Where do you want to keep INR iwth anticoag meds?
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2.5 (2.0-3.0)
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What to do if cannot take oral anticoagulants?
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325 mg ASA daily (antiplatlet med)
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Besides A-Fib when should anticoagulant be used?
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prostatic heart valves
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Should anticoag be used with PAD?
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No need antiplatlet meds like ASA 75-325/day or Clopidogrel 75 mg/day better in preventing MI, stoke or vascular death
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How to treat post management of pt with ST elelvaiotn MI (STEMI)
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daily ASA 75-162 mg, do not take ibuprofen as it blocks antiplatlet effect of ASA, use warfarin if allergic to ASA titrate to INR between 2.5-3.5 if used alone or with ASA 2.0-3.0
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How to manage pt with unstable angina/non-st elevationi MI
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without stenting ASA 75-162mg/day if using warafarin also increases risk of bleedign and must be monitored closly
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How long should ASA or Plavix be given after an MI?
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look up
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Is a beta blocker really that necessary after an MI?
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look up
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When to start ASA for at risk group for prevention & what dose
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men at 45 adn women at age 55. 81 mg
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Waht to ask with chest pain?
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1.Where, when did it start, how long, what aggravates, what alleviates, does it radiate, associated symptoms, has it ever happened before?
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What are some other causes of chest pain beside MI?
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herpes zodster, costochondroditis, pneumonia, pneumonthorax, PE, pulmonary hypertension, Aortic Stenosis, aoritc dissections, mitral vlave prolapse, pericarditis, reflux, cholecystitis
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What labs and test shoudl be ordred by someone presenting with heart failure?
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ht, wt, BMI, B/P lying, standing, CBC, Serum electrolytes, BUN, SErum creatinine, fasting glucose, lipid profile, LFT's, & TSH, 12 lead EKG & chest PA and lateral, echo
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What to asses with someone with unstable angina to rule out MI in a non-st sement elevation
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EKG, physical exam, cardiac markers, Is show ST elevation transort immediatly to hospital higher mortalibyt iwth ST elevation MI's
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What is another anti-platlet drug beside ASA?
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clopidogrel (plavix)
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How do beta blockers work in CAD?
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decrease myocardial oxygen consumption by decreasing HR at rest and with exercise, lowers B/P & reduces myocardial contractility, B1 receptors are in myocarium, B2 receptors primarliy in bronchoiles & pancreas use carefully in diabetic or pt with ashtma - use low doses
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How do nitrites work?
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treat stabel and unstable angina promote vascular smooth muscle relaxation, dilates vessels which decrease preload and afterload on heart+
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How do CA channel blockers work with angina/acute MI?
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selectively inhibit influx of CA into cell in both smooth muscle and myocardial cells. Will dilate peripheral and coronary arterioes do not use with HF as can make worse, nifedipine, verapamil, diltiazem
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How do ACEI work with angina/acute MI?
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renin-angiotensioaldosterone system of body increases preload, afterload, heart rate and sympathetic tone. ACEI will stop this process as it revereses thi hemodynamic and neurohumoral abnormality taht is assoc with poor LVF
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What can cause heart failure
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anatomic or fx abnormality of teh heart, biochemical or physiologic abnormality otaht inc the mycoardial workload, or reduce o2 delivery 3) extracardiac factors that cause excessive demand on heart, etiology can be multifactorial: with HTN, diabetis, hyperthyroidism, metabolic syndrome, cardiomyopathy, Ischemic heart disease
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Waht is diastolic dysfunction?
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increased ventricular stiffness and ventricular compliance which inc cardiac pressure during filling or diastole so ventricle does not relax and recieve adequate oxygen
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What is systolic dysfunction?
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MOst common HF, decrec in ejection fraction adn cardiac ouput. Altered preload, contractility adn afterload.
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What is preload?
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The degree of myocardial stretch at teh end of ventricular filling
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What is afterload?
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Amount of left ventricular wall tension that develops during systole to eject blood
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Waht clinical s/s are seen iwth heart failure?
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ddyspnea and fatigue most, orthopnea, brochospasm and wheezing, crackles, hemoptysis and dysphaia, end stage pulomnary edema, abnormal heart sounds S3 & S4, jugular venous pressure, hepatomegaly and periph. edema
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What are some lab tests taht are done to look for HF?
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BNP (brain natriureti peptide, is synthesized by teh ventricular myocardial cells in response to end-diastolic pressure and volume, Urotensin II:
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When should Dig be used with HF
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pt with A-fib and HF, pt who have dyspnea at rest 3. those who remain symptomatic despite diuretica ACE inib and Beta blockers.
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What is the patho of blood pressure?
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product of cardiac output and circulating volume and its' impact on myocardial stretch nd peripheral reistance
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What s/s are seen with hypertension?
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usually none so screening very important. s/s only seen after organ damage, secondary s/s seen like diabetic neuropathy adn cusing sydnrome
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How does JNC-7 reccommend B/P reading?
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abstain from alcohol and tobacco, use appropriate size cuff, need an average measurement of 2 readings
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What physiological changes happen iwth inc B/P?
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retinal changes d/t narrowing of arteries, carotid or aortici bruits, and imparied cerebreal circulation, adventitious lung sounds r/t cardiac dysfunction, skin and hair changes,
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What is first line for antihypertensive drug?
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diuretics (thiazide first line) can cause hypokalemia nad usually supplimented with K+
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What causes infective endocarditis?
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mostly bacterial (usually strep or staph with IV drug users - need to do a bld culture) infection in teh heart muscle usually starting with heart valves seen in mitral valve prolapse, prothetic valve replacements, congenital heart anomolies, degenerative valve disease and IV drug use, rhemuatic heart lesions
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What are s/s of infective endocarditis?
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early s/s fatigue,malaise, night sweats, c hills,and mod weight loss. can have fever, heart murmur heard in majority of pts., janeways lesions or Osloers node seen as hemorrhagic macules on palms or soles of feet or painful nodules on toes or fingers, can come down with CHF - usual cause of death
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What does CHADS score stand for in regards to A-fib?
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Cardiac failure, Hypertension, Age, Diabetes, Stroke History
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What is the pregnancy category of Pradaxa (dabgatran) an oral anticoagulant?
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C
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What are pros & cons for using dabigatran over coumadin?
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no routine monthly monitering, minimal iside effects, low food and drug interactions, costly at $240/month no antidote available - irreversible, Coumadin needs to modify diet to reduce Vit K, no alcohol while on coumadin no OTC meds unless approved
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What can help slow down the AV node?
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valsalvar manuever or carotid sinus massage
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Waht labs should be drawn when seen arrthymias?
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hgb, to check for anemia, TSH to check for hyperthyroidism, electrolytes (hypokalemia or hypomagnesiam) blood glucose, dig levels if on dig
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What is the difference between VT and SVT
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the QRS in SVT is less than 0.12 and originates above AV node
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What is PSVT?
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Paroxysmal Supraventricular Tachycardia - 140-240 starts and stops abruptly with valsavlar maneuver or CArotid sinus massage
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What is rate of Atrial Flutter
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250-350
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What is rate of Atrial Fib?
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350-650
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How long is QRS with VT?
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wider than 0.12, regular rhythum at 100-300, no P waves associated with QRS often longer than 0.14
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What are causes of A-fib?
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hypertension, cardiomyopathy, rhematic heart disease, mitral valve disease, CHD, hyperthyroidism, alcohol intoxication or withdrawal,stimulant ingestion acute pulmonary disease - need to treat with anti thromibin
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Name 2 Diastolic murmurs?
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Aortic REgurg, & Mitral Stenosis
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What meds can be used to decrease rate of A-fib?
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Amiodarone, beta blockers, CA channell blockers, adn maybe DIg
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What is complex ventricular ectopy?
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more than 10 PVC's per minute over 24 hours This is a diseased heart
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How to treat V-TAch
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synchronized cardioversion. ICD implantation,
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wHAT causes brady arrhythimias?
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SA or AV block
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How to describe systolic murmurs?
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ejection type (midsystolic) or regurgitant type (pansystolic) ejectiion grade 1 or 2, aortic stenosis, pneumonic stenosis or idiopathic hypertrophic ubaortic stenosis - most murmurs are one o these
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Describe mumurs from a high pressure chamber to a low pressure chamber
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usually from incompetant valves, mitral or tricuspid regurgl or VSD, systolic in nature
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What can be an outcome of Aortic stenosis?
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Left ventricular dilation, left atrial enlargment and pulmonary hyper tension
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Which mumurs shoudl be treated with antibiotics to prevent infective endocarditis?
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Aortic Stenosis
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What does aortic regurg cause?
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volume overload in the left ventricular which increase end diastolic pressure
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What problems does Mitral regurg manifest?
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Can cause stretching or thinning of right atrial wall as bld is injected back into atrium, left ventricular hypertrophy, pulmonary edema nad pulmonary hypertension over a long time, increases to any factor that increases resistance to forward flow (hypertension AS, CAD)
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What are s/s of mitral regurg?
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nothing initially can be s/s free for decades. First sign fatigue, then dyspnea on exertion, by time s/s come may have irreversible damage to heart
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Where does mitral regurg murmurs radiate to?
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axilla, standing will decrease murmur and clenching fists will increase murmur
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What is best way to diagnose MR?
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echocardiogram
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What causes Mitral Stenosis?
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rheumatic fever
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What problems does mitral stenosis cause?
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increased pressure in right atrium, pulmonary hypertension or right sided ventricular hypertrophy d/t increased pressure into lungs and back into right side of heart
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What changes can be seen on EKG with mitral stenosis?
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widened or notched P wave, in lead II, right axis deviation, a fib common
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Who should get prophaytic antibiotics for dental procedures to prevent infective endocarditis?
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Prosthetic cardiac valve or prosthetic material used for cardiac valve repair
Previous IE Congenital heart disease (CHD)* Unrepaired cyanotic CHD, including palliative shunts and conduits Completely repaired congenital heart defect with prosthetic material or device, whether placed by surgery or by catheter intervention, during the first 6 months after the procedure Repaired CHD with residual defects at the site or adjacent to the site of a prosthetic patch or prosthetic device (which inhibit endothelialization) Cardiac transplantation recipients who develop cardiac valvulopathy |
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What factors contribute to primary hypertension?
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Obesity
Diet Lack of exercise Salt intake Stress Caffeine Smoking Genetics |
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What are some causes of secondary hypertension?
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Renal artery stenosis – abdominal bruits, inc plasma renin activity
Pheochromocytoma - Spot urine VMA, 24 hour urine VMA, & metanephrines Cushings syndrome – 24 hour urine free cortisol Coarctation of the aorta – Chest X-ray, chest CT, & aortogram Thyroid disorder – TSH, triiothyronine, & thyroid binding hormone Various kidney disorders Sleep Apnea Pregnancy Anxiety Alcohol or cocaine use Steroids, Oral Contraceptives, HRT, NSAIDS, MAO inhibitors, OTC cold remedies, & weight control medications |
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What are red flags for secondary hyp-ertension?
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Younger people experiencing high blood pressure
Patients who you are treating with 3 or more antihypertensive medications and are not responding to treatment. |
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What not to prescribe for someone with secondary high B/P r/t renal stenosis?
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Angiotension converting enzyme inhibitors or angiotension receptor blockers for patients with RAS, as these can cause renal failure
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If someone is allergic to sulfa can you prescribe a thiazide diuretic?
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Thiazide diuretic is OK to give with someone allergic to a diuretic,
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How would changing hypertensive drugs differ for an elderly adult?
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His medications would change only if he had a condition that warranted a change such as kidney insufficiency. JNC 7 states that care for elderly populations with HTN can follow the same guidelines dictated for HTN, but a lower dose may be needed for initiating medications
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What are ATP Risk factors besides LDL?
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smoking, hypertension, Low HDL, fam Hx of CHD, age > 45 men, > 55 women, diabetes
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Which cardiac markers shoudl be tested with chest pain?
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Troponin, CKMB, CPK
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What does CHADS stand for?
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Cardiac failure
Hypertension Age Diabetes Stroke history Is used to decide risk of stroke and need for anticoagulant |
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What is first oral anti-coagulant approved inUS in over 50 years?
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Pradax (dabigatran) - no monitoring required like warfarin
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What can precipitate atrial fib?
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Heart disease
Hyperthyroidism Acute MI Cardiac surgery COPD Digoxin toxicity Hypertension Pericarditis Triggers (alcohol, caffeine, nicotine) |
