UCSF VALOR Accquifer Case 9

History

100

The patient's name

Who is Ms. Yang?

200

Synonym for the vasomotor symptoms of climacteric? Ms. Yang is currently experiencing this.

Menopause?

300

What were some of Ms. Yang's life stressors?

• Demanding, high-pressure profession
• Going through menopause
• Three teenage daughters
• Mother dying of heart disease

400

What age did her mother have an MI? What age increases familial risk for men and women?

Women <65

Men <55

Physical, Labs, and Imaging

100

Ms. Yang's significant physical exam findings?

Nothing!

200

With palpitations, what abnormality would you see on a CBC? TSH?

low Hgb --> anemia

low TSH--> hyperthyroidism

300

Ms. Yang's Labs. Which are abnormal?

Cholesterol-252 mg/dl

Triglycerides-151 mg/dl

HDL-47 mg/dl

LDL-175 mg/dl

normal cholesterol: 150-240

Triglycerides: less than 150

HDL: below 40 

LDL: less than 160

400

What is more cost-effective, a Holter monitor or loop recorder?

Loop Recorder

• Holter monitor is a portable electrocardiograph machine that allows readings to be made over a 24 to 48-hour period, while the patient is performing the usual activities of daily living at home or at work.
• Loop recorders increase the diagnostic yield with regard to detecting dysrhythmias in patients with palpitations and may be more cost-effective. These recorders can monitor heart activity for weeks to months, while the patient goes about her regular daily activities. A permanent record is kept only when the patient activates the recorder during periods when symptoms are felt.

Everything palpitations

100

Hyperthyroidism or Hypothyroidism causes palpitations.

What is Hyperthyroidism?

200

Duration of palpitations longer than 5 minutes suggest this etiology

I believe it is Coronary Heart Disease?

300

What percentage of palpitations had an unknown etiology?

16% or around there?

400

Are cardiac or psychogenic causes more likely causes of palpitatons?

In a prospective cohort study of 190 patients at a university medical center who complained of palpitations:

1. 31% had palpitations caused by anxiety or panic disorder

2. 43% percent had palpitations due to cardiac causes

Atherosclerotic Cardiovascular Disease

100

Considered high-intensity statins. Don't worry about dosage

Atorvastatin: 40 to 80 mg

Rosuvastatin: 20 to 40 mg

200

What level of LDL do we try to achieve with treatment in those with ASCVD?

Trick Question!

"Low density lipoprotein cholesterol (LDL-c) goals no longer recommended as treatment targets"

This will be my only one sorry!

300

What percent of women present with chest discomfort, in the setting of an MI?

29.7% reported chest discomfort

400

Four Indications for starting statinn therapy

1. Individuals with clinical ASCVD --> High-intensity statin therapy

2. Individuals 40 to 75 years with diabetes:--> Moderate-intensity statin

3. Individuals > 21 years with LDL-c > 190 mg/dL--> High-intensity

4. Individuals 40 to 75 years old with 10-year ASCVD risk > 7.5%-->

Moderate- or high-intensity