WEBVTT

1
00:00:00.332 --> 00:00:02.852
Maria's record says two pregnancies.

2
00:00:02.939 --> 00:00:06.811
It misses severe preeclampsia and
delivery at thirty-one weeks.

3
00:00:06.921 --> 00:00:10.268
Record those details and verify
the history when possible.

4
00:00:10.422 --> 00:00:14.052
They matter to today's prevention
discussion, but they do not establish

5
00:00:14.072 --> 00:00:18.134
that Maria already has atherosclerotic
cardiovascular disease.

6
00:00:18.482 --> 00:00:20.117
Build the current assessment.

7
00:00:20.219 --> 00:00:23.470
Review blood pressure,
the lipid profile, family

8
00:00:23.490 --> 00:00:27.030
history, actual medicines
and patient preferences.

9
00:00:27.188 --> 00:00:30.344
Lipoprotein little a
contributes inherited-risk

10
00:00:30.364 --> 00:00:34.242
information; it is not a
measurement of arterial blockage.

11
00:00:34.453 --> 00:00:38.182
The current guideline uses
PREVENT for primary prevention.

12
00:00:38.436 --> 00:00:41.596
Obtain the required inputs
before calculating risk.

13
00:00:41.801 --> 00:00:44.772
Do not invent a score from
this abbreviated case.

14
00:00:44.978 --> 00:00:47.816
Now consider the separate
pregnancy-planning branch.

15
00:00:48.030 --> 00:00:51.329
Review the exact medicine,
why it is prescribed,

16
00:00:51.349 --> 00:00:53.981
and the patient's pregnancy
and feeding plans.

17
00:00:54.274 --> 00:00:56.293
The Food and Drug Administration advises

18
00:00:56.313 --> 00:00:58.833
stopping statins in most pregnant patients,

19
00:00:58.873 --> 00:01:01.129
while allowing individualized decisions

20
00:01:01.149 --> 00:01:04.180
for those at very high cardiovascular risk.

21
00:01:04.399 --> 00:01:06.729
If ongoing statin treatment is needed after

22
00:01:06.769 --> 00:01:09.787
delivery, breastfeeding is not recommended.

23
00:01:10.134 --> 00:01:14.138
Coordinate these decisions with the
prescriber and relevant specialists.

24
00:01:14.428 --> 00:01:16.806
For Maria, agree on the next prevention

25
00:01:16.846 --> 00:01:19.247
decision after completing the assessment.

26
00:01:19.358 --> 00:01:22.467
Explain what the pregnancy
history and lipid findings

27
00:01:22.487 --> 00:01:25.433
mean without predicting an
inevitable heart attack.

28
00:01:25.616 --> 00:01:27.789
Name who will follow up and when.