| Resistant Hypertension is most likely associated with: | OSA is found in 30-40% of hypertensive patients and 60-70% of patients with resistant hypertension, whereas primary aldosteronism is present in only 7-20% of patients with resistant HTN. Renal artery stenosis is seen in 2-24% of cases of resistant HTN in various studies, and renal parenchymal disease in 2-4%, and thyroid disease in less than 1%. |
| Pt on ASA + Clopidogrel before CABG surgery. | Stop only clopidogrel 5 days before surgery. Patients receiving dual antiplatelet therapy who require bypass surgery should continue taking aspirin. Clopidogrel or prasugrel should be stopped 5 days before the surgery due to the increased risk of major bleeding during surgery. |
| Asymptomatic Trivial Mitral Regurgitation. | The American Society of Echocardiography recommends that physicians NOT order follow-up or serial echocardiograms for surveillance after a finding of trace valvular regurgitation on an initial echocardiogram. Trace mitral, tricuspid, and pulmonic regurgitations can be detected in 70-90% of normal individuals and has no adverse clinical implications. The clinical significance of a small amount of aortic regurgitation with an otherwise normal echocardiographic study is unknown. |
| Long QT syndrome | Patients with repeated EKG showing a QTc interval >480 ms with a syncopal episode, or >500 ms in the absence of symptoms, are diagnosed with long QT syndrome if no secondary cause such as medication use is present. This syndrome occurs in 1 in 2000 people and consists of cardiac repolarization defects. It is associated with polymorphic ventricular tachycardia, including torsades de pointes, and sudden cardiac death. It may be treated with beta-blockers and implanted cardioverter defibrillators. |
| Naproxen (Aleve) | Is the NSAID that is safest for patients with a previous history of MI. All oral NSAIDs increase the risk of MI with the exception of naproxen. Cardiac risks are greater in older patients, those with a history of cardiac events, and with higher doses. |
| A-fib with RVR | A patient with a-fib has a heart rate of 140. Should you give adenosine? No. Never give adenosine to patients with a-fib. Adenosine is only for narrow complex, regular v-tach. To slow the rate of A-fib, you rate control with a BB or non-dihydropyridine CCB |
| Autosomal dominant polycystic Kidney disease patient with HTN. What is the first-line BP med? | ACE inhibitor (Lisinopril). HTN is the most common manifestation of autosomal dominant PCKD and it also contributes to worsening renal function and an increased risk of CVD and death. ACE inhibitors such as lisinopril are first-line agents because they have renal protective benefits in addition to their effects on blood pressure. Some studies have suggested they help slow the decline in renal function and help prevent left ventricular hypertrophy (more than diuretics or CCB). ARBS should be reserved for those who cannot tolerate ACE inhibitors. |
| Start statins before coronary revascularization to reduce CV risk. | Statins are drugs of choice to reduce perioperative cardiovascular risks. In addition to 1) lowering cholesterol, they also 2) reduce vascular inflammation, 3) improve endothelial function, and 4)stabilize atherosclerotic plaques. |
| Giant Cell Arteritis (Temporal Arteritis) | Treatment involves high-dose corticosteroids, which may cause significant morbidity. As such, many MDs prefer to confirm the diagnosis with a temporal artery biopsy prior to committing a patient to full treatment. |
| PMR and GCA often coexist | Polymyalgia rheumatica and giant cell arteritis are common, closely related vasculitic conditions that almost exclusively occur in patients older than 50 years. They may be manifestations of the same underlying disease and often coexist |
| TIA and stroke patients should be on statins! | Statins are effective for preventing stroke, which should be the key goal in these high-risk patients. They may stabilize the intimal wall.
*FYI: Patients over 70 years have worse outcomes with carotid stenting than endarterectomy. |
| Hyperaldosteronism | See question and workup. |
| Pericarditis | Patients with pericarditis should be treated empirically with colchicine and / or NSAIDs for the first episode of mild to moderate pericarditis. Glucocorticoids are typically reserved for use in patients with severe or refractory cases or in cases where the likely cause of pericarditis is CTD, autoreactivity, or uremia. |
| SVT | Treatment of SVT |
| ACE inhibitors creatinine increase | You start a patient on lisinopril. It works great and brings her BP down to desired level. However, the creatinine increases from 1.25 to 1.5. What should you do? Continue lisinopril at the current dosage. ACE inhibitors like lisinopril do not need to be discontinued unless the baseline creatinine increases by >30%. |
