2.8.2013 Flashcards
Adverse prognostic factors in stable ischemic heart disease
H/O previous MI recent episode of unstable angina/new onset angina EF<50% HT,DM,dyslipidemia Increasing age Family h/o CAD
FFR
Fractional flow reserve
________ is a powerful predictor of short and longterm course of SIHD
LV function
Intermediate and high risk groups in SIHD based on EF
Intermediate- 35 to 49%
High - less than 35%
Maximum anti ischemia therapy
Atleast two classes were used
Which is preferred for restenosis after CABG?
repeat CABG or PCI
PCI
Hybrid coronary revascularisation
LIMA for LAD
PCI of other stenosed coronary arteries
Role of dual anti platelet therapy in chronic stable angina
No role
Clopidogrel is given only for aspirin allergic pts
Nicorandil is useful for
Microvascular angina
BP control in SIHD
Less than 140/90
Less than 130/80 in diabetics and CKD pts
Aggressive control(120/80) in young pts and hypertensives of short duration
Effect of PUFA on cholesterol
Decreases both LDL and HDL
MUFA doesnot reduce HDL
Lipid therapy in SIHD
High risk(risk factors or CAD equivalents are present) LDL less than 100 Non HDL C less than 130 Very high risk(ACS or established CAD) LDL less than 70 Non HDL C less than 100
Goal HbA1C in SIHD
Less than 7%
Role of ACE inhibitors in SIHD
EF less than 40%
CKD
DM
Rx of refractory angina
Enhanced external counterpulsation
Spinal cord stimulation
Mechanism of enghanced external counterpulsation
Similar to IABP
Conduits used in CABG
Saphenous vein Internal thoracic artery Radial artery Rt gastroepiploic artery Inferior epigastric artery Cryo preserved homograft veins
Which is the best bypass conduit?
LIMA
Why LIMA is best bypass conduit?
Endothelium produces EDRF and prostacyclin
Tight internal elastic lamina
How ischemia of myocardium during bypass is prevented?
Infusion of k+ rich solution which arrests heart in diastole
Complications of CABG
1.Neurological dysfunction
Renal dysfunction
SIRS
Indications for CABG
Left main stenosis
Non LMS
TRIPLE vessel disease with more than 70% stenosis
Proximal LAD + 1 major coronary vessel
RIMA is used in
Dextrocardia
Pump head syndrome
Neurocognitive deficits after On pump CABG
Role of folates in SIHD
No role(though they were thought to play a role by reducing homocysteine level)
