Approach to the Cardiovascular Patient 2024_S_Aubrey Scott.pdf

It is astonishing with how little reading a doctor can practice medicine, but it is not astonishing how badly he may do it. Sir William Osler  Approach to the Cardiovascular Patient Lee Scott MD [email protected] Objectives 1. Describe the importance of being knowledgeable about c...

It is astonishing with how little reading a doctor can practice medicine, but it is not astonishing how badly he may do it. Sir William Osler  Approach to the Cardiovascular Patient Lee Scott MD [email protected] Objectives 1. Describe the importance of being knowledgeable about cardiovascular disease as a future physician. 2. Describe the relationships that exist in the United States between age, race, and gender and various cardiovascular diseases and outcomes. 3. Recognize risk factors for cardiovascular disease. 4. Recognize the 2020 AHA goals for 'ideal cardiovascular health.' 5. Explain the importance of assessing a patient's baseline level of activity. 6. Take an appropriate history for the most common cardiac presentations- chest pain, dyspnea, palpitations, swelling, syncope. 7. Recognize atypical presentations of angina and MI. 8. Identify a patient's most likely diagnosis for a given HPI. (acute vs chronic, mild vs severe, radiating to arm vs back, etc.) 9. Identify key factors in the past medical, family, and social history that contribute to the patient's illness and/or help in making the diagnosis. 10. Select appropriate review of systems questions to ask a patient with a cardiovascular chief complaint. 11. Select an appropriate physical exam to perform on a patient with a cardiovascular chief complaint. 12. Use both positive and negative physical exam findings to develop a working diagnosis for a patient with a cardiovascular problem. 13. Formulate a logical and comprehensive plan for a patient with a cardiovascular problem. Cardiovascular Disease What does that encompass? Cardio Vascular Heart and EKG, Harvard Health Publishing, April 20, 2020 Why is it important that you know a lot about cardiovascular disease? Cardiovascular Disease consists primarily of : hypertension (the vast majority of diagnoses) coronary vascular disease heart failure stroke 2020 affected 38.7% US population projected to increase to 40.5% in 2030* (NIH) (100,600,000 US adults currently) is the leading cause of death in the United States accounting for almost 931,578 deaths in 2021 * (AHA) Cardiovascular Disease Death rates have been declining due to both reduction in cardiovascular risk factors, or primary prevention, and improvements in secondary prevention—treatments following clinical CVD events, such as heart attack and stroke. However, CVD still accounts for about one of every three deaths (2020)* in the United States, and obesity, diabetes, hypertension, physical inactivity, and tobacco use present important challenges to achieving greater reductions in the burden of CVD. *(AHA)  CVD Factoids Average age at the first heat attack Males 65.6 years Females 72.0 years Every 40 seconds someone in the US will have a myocardial infarction. 2021 stroke accounted for approximately 1 in every 21 deaths in the US Stroke caused 162,890 deaths in the US in 2021 – about every 3 mins and 14 seconds In 2021 Heart disease and stroke claimed more lives than all forms of cancer and chronic lower respiratory disease combined. States with the highest age-adjusted CVD related death rates per 100 000 people between 2019 and 2021 were Alabama, Oklahoma, and Arkansas (308.6, 303.2, and 290.3 per 100 000 people, respectively). Let’s talk about: Risk reduction Race Gender 2020 AHA goals promote the concept of “ideal cardiovascular health” Defined as: The absence of clinically manifest CVD PLUS The simultaneous presence of optimal levels of seven health metrics: 1. lean body mass index