Cp2 Dr Dew

Front 1

number one cause of death in the US

Back 1

coronary artery disease. estimated 490,000 deaths/year

Front 2

most common presenting symptom of CAD

Back 2

angina

Front 3

epidemiological evidence shows ___ is cause of CAD

Back 3

lifestyle choices. Ex/japanese that move to US have high CAD rate, not genetic

Front 4

Framingham Heart study

Back 4

identified common attributes to CAD. Was a cohort study of over 5000 people. went on for over 60 years and they followed the 2nd generation of the initial subjects, too. (followed genetics)

Front 5

cohort study

Back 5

identify individuals who are healthy at this time who have different lifestyles and watch the disease develop over 10-20 years.

Front 6

Findings of the framingham study (what increases risk of CAD)

Back 6

1)cigarette smoking significantly increased risk of CAD
2) cholesterol, blood pressure and EKG abnormalities
3) lack of physical activity
4) menopause increased the risk
5) psychosocial, HDL cholesterol

Front 7

What is the strongest predictor of risk for CAD?

Back 7

AGE. Men over 45 and women over 55

Front 8

List the 10 risk factors for CAD

Back 8

1) Age
2) male gender
3) family history
4) HTN
5) cigarette smoking
6) obesity
7) physical inactivity
8) diabetis
9) low HDL cholesterol (less than 35 men, or 45 women)
10) increased LDL (more than 159)

Front 9

Is smoking more detrimental to women or men?

Back 9

women

Front 10

formula for cholesterol

Back 10

Total cholesterol= HDL + LDL + VLDL

Front 11

total cholesterol level is not a very good indicator of risk for CHD because:

Back 11

there is a combination of good and bad cholesterol. We need to know LDL and HDL levels...

Front 12

HDL levels

Back 12

desireable level should be greater than 50 in women and greater than 35 in men

Front 13

LDL levels

Back 13

should be under 160 in asymptomoatic pts, under 130 in pt's with angina, under 70 in pts with hx MI or diabetes ( Lower is better) * he said we don't need to memorize all the cutoff values*

Front 14

Dietary protein

Back 14

controlled studies keeping everything constant except the amount of protein found that the protein content itself wasn't a risk. The saturated fat in the meat is the risk factor.

Front 15

Dietary carbohydrate

Back 15

refined sugar has + association with CAD.
there is a negative relationship between complex carbs and CHD.

Front 16

Alcohol and CAD

Back 16

in general 20-40% decrease in risk for CAD for those who drink sparingly (1-2 drinks a day.. 5 oz glass of wine)

Front 17

alchohol and HDL levels

Back 17

evidence that alcohol increases HDL levels, helps break up clots when they form, red wine is the more beneficial type of alcohol

Front 18

physical activity and heart disease

Back 18

couch potato= 2x more likely to die from CHD.
In the sedentary, 35% of the excess CHD could be eliminated if we were more physicall active

Front 19

Obesity and CHD

Back 19

weight gain since youth is strong indicator, not good to be too thin, or obese. U shaped relationship

Front 20

Metabolic syndrome

Back 20

also called pre-diabetis. combination of 3 things
1) HTN
2) high blood sugar
3) lipidemia

Front 21

Normal fasting glucose.Cut off for diabetis

Back 21

less than 100 is normal
greater than 126 is diabetic

Front 22

C-reactive protein

Back 22

an inflammatory marker, strong independent risk for CVD. Risk can be significantly reduced by taking ASA

Front 23

Cytomegalovirus

Back 23

has been isolated from atherosclerotic placques

Front 24

helicobacter pylori

Back 24

higher rate of sero-positivity among patiens with CHD than normal controls

Front 25

Chlamydia pnemoniae

Back 25

much higher antibody titers in MI patients than in controls. Clinical trials of macrolides showed dramatic reduction in coronary events in pts with CHD

Front 26

HTN

Back 26

strong independent factor. recently found that systolic BP is more important than diastolic!

Front 27

tobacco smoking

Back 27

2x as high as non-smokers, more significant in women than men, for those who quit smoking the risk drops quickly and is minimal after a year of non-smoking

Front 28

what does smoking do specifically?

Back 28

accelerates blood clotting, increases blood CO levels causing a reduction in the delivery of oxygen, nicotine is vasoconstrictive.

Front 29

primary prevention of coronary artery disease

Back 29

1) screen for HTN
2) Screen for High cholesterol
3) counsel for tobacco use
4) counsel for physical activity
5) counsel to promote healty diet

Front 30

rheumatic heart disease

Back 30

delayed complication of upper respiratory infection with group A strep.
all layers of the heart may be involved

Front 31

prevention of rheumatic heart disease

Back 31

throat cultures, + culture should be treated, mass throat cultures in schools have been advocated because many don't seek treatment when sick.

Front 32

Carotid artery stenosis

Back 32

increased risk for stroke, MI and death. 1/2 % of people in 50's and 10% of people in 80's have stenosis more than 50%

Front 33

PAD, peripheral artery disease

Back 33

caused by atherosclerosis of the aorta and lower extremity arteries. may cause intermittent claudication (pain in aorta with exertion) strongly associated with CHD. palpation of peripheral pulses is unreliable. routine screen for asyptomatic pts is not recommended.

Front 34

AAA

Back 34

abdominal aortic aneurism. focal dilation of aorta at least 150% of normal. estimated 8700 deaths/year in US. fatal if ruptures unless promt surgery. abd palpation is helpful during PE, however insufficient evidence for or against routine screening.