Comprehensive Management of Cardiovascular Risk Factors for Adults With Type 2 Diabetes
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Course
RN - Registered Nurse
Institution
RN - Registered Nurse
Comprehensive Management of Cardiovascular Risk Factors for Adults With Type 2 Diabetes
Comprehensive Management of Cardiovascular Risk Factors for Adults With Type 2 Diabetes
Cardiology
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1. The worst risk factor for stable angina: Diabetes mellitus
2. Most common risk factor for stable angina: Hypertension
3. Major risk factors for CAD: DM -
worst Hyperlipidemia - elevated LDL
HTN
smoking
age (men >45; women >55
yrs) family hx of premature
CAD or MI low levels of HDL
4. How to calculate a person's max HR: 220-age
5. How would ischemia appear on a exercise stress test for CAD?: exercise-
in- duced ischemia -> subendocardial ischemia -> ST-segment
depression.
Other +ve findings: HF, Ventricular arrhythmias, or hypotension.
6. List steps in diagnosis of Coronary Artery Disease (CAD): 1. Physical
exam
- usually normal
2. resting ECG
3. Stress test (ECG)
- exercise (ST depression)
- pharmacologic
- adenosine & dipyramidole -> generalized vasodilation
- dobutamine -> increases myocardial O2 demand (increases HR, BP,
contractility) Stress test (echo)
- wall motion abnormalities seen after
exercise more sensitive than stress ECG
4. Holter monitoring
5. Cardiac catheterization
7. definitive Inv for CAD: cardiac catheterization with angiography
8. Treatment for stable angina that lowers mortality: aspirin (reduces risk of
MI) & beta-blockers (reduce frequency of coronary events) decrease
mortality
- nitrates relieve pain.
9. side effects of nitrates (when used for CAD):
headache orthostatic hypotension
toleranc
e
syncop
e
, Cardiology
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10.Which modifiable risk factor for CAD has greatest effect?: smoking -
cessa- tion halves risk by 1 year after quitting.
11.When is aspirin indicated in mgmt of CAD?: aspirin (& risk factor
modifica- tion) indicated in all pts.
, Cardiology
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12.General guidelines for mgmt of CAD: beside aspirin & risk factor
modifica- tions, depends on severity
Mild disease (normal EF, mild angina, single-vessel disease)
- nitrates (for symptoms & prophylaxis) & beta-blockers
- atenolol & metoprolol = 1st-line.
- consider Ca2+ blockers if symptoms persist, despite
mgmt. Moderate disease (normal EF, mod angina, 2-
vessel disease)
- mgmt for mild + consider revascularization (PCI or CABG)
Severe disease (decreased EF, severe angina, 3-vessel/L-main/LAD)
- angiography & consider for CABG.
13.What distinguishes unstable angina from NSTEMI?: cardiac
enzymes; NSTEMI has elevated troponin or CK-MB
14.Steps in diagnosis of unstable angina:: same as for stable CAD, plus
1. workup to exclude MI
2. pts with unstable angina have higher risk of adverse event during
stress testing. Thus they should be stabilized first or proceed straight to
catheterization.
15. Broad outline of treatment for unstable angina: 1. admission with
continuous cardiac monitoring
2. aggressive medical mgmt - treat as MI (w/o fibrinolytics)
3. Cardiac cath/revascularization
4. Long-term treatment
16. Describe aggressive medical mgmt for unstable angina: 1. aspirin
2. clopidogrel (CURE trial -> dual antiplatelet therapy is best)
3. beta-blockers: 1st-line therapy if no contraindications.
4. LMWH to prevent clot progression/development
- cont for at least 2 days
- Enoxaparin = DOC (ESSENCE trial)
5. nitrates: 1st-line
6. O2 if pt hypoxic
7. GpIIb-IIIa inhibitors (abciximab, tirofiban) = useful adjuncts, esp if pt
undergoing PCI.
8. morphine (controversial, as it may mask worsening symptoms)
9. replace electrolytes, esp K+ and MG2+
17. Long-term mgmt of unstable angina: 1. continue aspirin (or other an-
tiplatelets), beta-blockers, and nitrates
2. reduce risk factors
18.Definitive test for Prinzmetal's angina: coronary angiography - displays
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