CV Note

EXERCISE TREADMILL TESTING INDICATION

當病人出現疑似CAD的symptoms，resting ECG表現為正常，且自身條件足以進行，peak heart rate至少要達(220 − age) x 85%。若原本EKG已有不正常finding，可能sensitivity and specificity會下降。當ST-segment depression (horizontal or downsloping > 0.1 mV and lasting > 0.08 sec) 應強烈懷疑CAD。在女性、atypical 或 no chest pain、anemia的患者可能出現False positives的情形。

MYOCARDIAL PERFUSION IMAGING

注入nuclear medicine(dipyridamole or adenosine) induce coronary vasodilation,增加healthy coronary arteries flow，stenosis的血管flow相對減少，dipyridamole (Persantine) or adenosine會造成bronchoconstriction，COPD是一個重要的contraindicationas。

Functional Classification of Heart Disease

Class I: No limitation of physical activity. (正常人)

Class II: Slight limitation of physical activity. (輕微)

Class III: Marked limitation of physical activity. Comfortable at rest, but less than ordinary activity causes symptoms. (明顯的症狀)

Class IV: Unable to engage in any physical activity without discomfort. Symptoms may be present even at rest. (連休息也會有症狀)

Hypertension

First-line：diuretics, beta blockers, ACEI, ARB, CCB.

Goal is SBP<135–140 systolic, DBP<80–85 (<130/80 in patients with DM or CKD).

A、ACEI：Side effects include angioedema, hyperkalemia and azotemia (particularly in pts with elevated Cr), nonproductive cough-->substitute an ARB

B、Beta Blockers：Relative contraindi-cations include bronchospasm, CHF, AV block, bradycardia, and insulin-dependent diabetes.

C、CCB

1、DHP：

長效：Amlodipine, Nifedipine-MR

短效：Nifedipine, Nicardipine

降低 afterload, 擴張coronary artery, 減低inotropic(但Amlodipine可能在LVF使用)

2、NDPH：verapamil, diltiazem

減低inotropic更明顯，應避免在急性CHF使用

D、Diuretics：

Major side effects include hypokalemia, hyperglycemia, and hyperuricemia