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ACC/AHA Guidelines > ACC AHA part 1 > Flashcards

ACC AHA part 1 Flashcards

1
Q

2017 Recomendation of severe secondary vs primairy MR -

  • ERO
  • Regurgitant volume
A

Some data has suggested that with severe secondary MR, a smaller ERO should be used

(? weakend ventricle, correlates with regurg volume)

Recs unchanged:

ERO: >0.4cm2 (more specific), ERO 0.2cm2 (more sensitive)

Regurg volume > 60ml

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2
Q

reccomendataion for patient with :

Decreased exercise tolerance

Exertional dyspnea

ERO = 0.5cm2

LVEF > 30

A

1B evidence for Surgery

Standing 2014 guideline -

Mitral valve surgery is recommended for symptomatic

patients with chronic severe primary MR (stage D) and

LVEF greater than 30%

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3
Q

reccomendation for patient with:

no symptoms

Chronic severe MR

LVEF 45%

LVESD 40mm

A

1B recomendation is surgery.

The 2014 recs stand:

Mitral valve surgery is recommended for asymptomatic

patients with chronic severe primary MR and LV dysfunction

(LVEF 30% to 60% and/or left ventricular end-systolic

diameter [LVESD] ‡40 mm,

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4
Q

Recomendation for a patient with:

no symptoms

Chronic severe primairy MR

LVEF: 65%

LVESD 35mm

A

Surgery:

  • if the liklihood of a successful repair is >95% and expected mortality is <1% at a heart valve center of excellece:

IIa B recomendation is for mitral valve repair

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5
Q

From a Mitral data perspective, what does an LVEF of 60% and a LVESD > 40 indicate

A

The presence of systolic LV dysfunction

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6
Q

Mitral regurgitation:

Other than LVEF (<60) and LVESD > 40mm, what data can push a patient with primairy MR to surgery ?

A
  1. New onset atrial fibrillation
  2. Pulmonary artery systolic pressure > 50mmHg

IIa B recomendation:

Mitral valve repair is reasonable for asymptomatic patients

with chronic severe nonrheumatic primary MR (stage C1) and preserved LV function (LVEF >60% and LVESD <40 mm) in whom there is a high likelihood of a successful and durable repair with 1) new onset of AF or 2) resting pulmonary hypertension (pulmonary artery systolic arterial pressure >50 mm Hg

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7
Q

Anticoagulation for patients with rheumatic mitral stenosis and atrial fibrillation

A

Anticoagulation with vitamin K antagonist

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8
Q

Reccomendatioins for antibotic prophylaxis with dental procedures IE prophylaxis ?

A

Prophylaxis against IE is reasonable before dental procedures that involve manipulation of gingival tissue, manipulation of the periapical region of teeth, or

perforation of the oral mucosa in patients with the

following (13,15,23–29):

  1. Prosthetic cardiac valves, including transcatheterimplanted

prostheses and homografts.

  1. Prosthetic material used for cardiac valve repair,

such as annuloplasty rings and chords.

  1. Previous IE.
  2. Unrepaired cyanotic congenital heart disease or

repaired congenital heart disease, with residual

shunts or valvular regurgitation at the site of or

adjacent to the site of a prosthetic patch or

prosthetic device.

  1. Cardiac transplant with valve regurgitation due to a

structurally abnormal valve.

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9
Q

DOAC

A

DOAC= Direct oral anticoagulants-

Apixaban (Eliquis®)

Dabigatran (Pradaxa®)

Rivaroxaban (Xarelto®)

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10
Q

class IA reccomendations for TAVR

A

Class IA Recs

TAVR is recommended for symptomatic patients with severe AS (Stage D) and a prohibitive risk for surgical AVR who have a predicted post-TAVR survival greaterthan 12 months

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11
Q

​Valve hemodynamic criteria for Symptomatic severe high-gradient AS?

A

​Valve hemodynamic criteria for Symptomatic severe high-gradient AS

  1. valve hemodynamics:
    1. aortic velocity 4.0 m/s or higher,
    2. corresponding to a mean trans-aortic gradient of 40 mm Hg or higher.
    3. valve area is <1.0 cm2 with an indexed aortic valve area of < 0.6 cm2/m2
    4. but it may be larger, with mixed stenosis and regurgitation.
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12
Q

​Valve hemodynamic criteria for Symptomatic severe high-gradient AS

valve hemodynamics:

velocity?

A

​Valve hemodynamic criteria for Symptomatic severe high-gradient AS

valve hemodynamics:

aortic velocity 4.0 m/s or higher

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13
Q

​Valve hemodynamic criteria for Symptomatic severe high-gradient AS

valve hemodynamics:

mean transaortic gradient:

A

40 mm Hg or higher.

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14
Q

​Valve hemodynamic criteria for Symptomatic severe high-gradient AS

valve hemodynamics:

valve area: .

A
  • valve area is <1.0 cm2
  • indexed aortic valve area of < 0.6 cm2/m2

but it may be larger, with mixed stenosis and regurgitation.

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15
Q

TAVI

Severe symptomatic low-flow low-gradient With low EF:

A

TAVI

Severe symptomatic low-flow low-gradient With low EF:

  1. severe AS with a low left ventricular (LV) ejection fraction (EF) (<50%)
  2. defined by a severely calcified valve with:
    1. reduced systolic opening and an aortic valve area <1.0 cm2.
    2. Aortic velocity is ≤4.0 m/s at rest but increases ≥4.0 m/s on low-dose dobutamine stress echocardiography.
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16
Q

TAVI

Severe symptomatic low-flow low-gradient severe AS with a normal LVEF

ECHO CRITERIA

A

Severe symptomatic low-flow low-gradient severe AS with a normal LVEF

  1. aortic valve area <1.0 cm2 with a
  2. aortic velocity <4.0 m/s
  3. mean gradient <40 mm Hg.
  4. indexed aortic valve area <0.6 cm2/m2
  5. stroke volume index <35 ml/m2
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17
Q

TAVI

Patient specific factors important to evaluating TAVI candidacy

A

Per 2014 Guidelines:

integrated assessment combining

  1. the Society of Thoracic Surgeons (STS) Predicted Risk of Mortality score
    • the STS score: <4% (low risk),
    • 4% to 8% (intermediate risk),
    • >8% (high risk).
  2. frailty
  3. main organ system dysfunction
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18
Q

TAVI Evaluation

Major CV comorbidities assessed?

A

Major CV Comorbidities assessed:

  1. Coronary artery disease
  2. LV systolic dysfunction
  3. Concurrent valve disease (MR/MS)
  4. Pulmonary hypertension
  5. Aortic disease (porcelain aorta)
  6. Peripheral Vascular disease
  7. Hostile chest / prohibitive previous open heart surgery
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19
Q

TAVI Evaluation

Major non-CV comorbidities

A
  1. Malignancy (remote, active, impact on life expectancy)
  2. GI and liver Disease
  3. GIB, IBD, Cirrhosis,
  4. GFR < 30cc/min/1.73m2
  5. HD
  6. O2 requirement
  7. FEV1 < 50% predicted
  8. DLCO < 50% predicted
  9. Neurologic disorders
    1. Movement disorders, dementia
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20
Q

TGA

what are the two major anatomic variants?

And their relative frequency

A
  1. Two major subdivisions
    1. “Simple TGA” – 60- 70%
    2. “VSD” 30-50%
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21
Q

TGA

frequency of VSD + Pulmonary stenosis

A
  1. VSD and pulmonary stenosis : 10%
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22
Q

TGA

frequency of a subaortic conus

A

Subaortic conus : 90%

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23
Q

TGA

frequency of PFO

A

PFO in nearly all

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24
Q

TGA

if left uncorrected, when does the LV thickness begin to decrease

A

1 month

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25
Q

TGA

what form of TGA presents with severe cyanosis after birth?

A

TGA + IVS

Cyanosis depends on the level of mixing –

no mixing

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26
Q

TGA

What form presents with mild cyanosis and heart failrue in the first month ?

Why?

A

TGA with a large PDA/VSD (and no LVOTO)

Cyanosis depends on mixing - large PDA or VSD permit mixing

LVTOTO would prevent the ammount of pulmonary over flow (pulmonary vascular bed has low resistance)

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27
Q

TGA Presentation of:

TGA / Large VSD / LVOTO?

Why?

A

severe cyanosis without heart failure

Cyanosis depends on the mixing

LVOTO controlls the over circulation through the pulmonary bed, which is controlled by the LVOTO

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28
Q

TGA Presentation of:

TGA / large VSD or PDA / NO LVOTO ?

Why?

A

Heart failure within the first month, mild cyanosis

cyanosis depends on mixing - provided by VSD/PDA

no LVOTO to inhibit the inhibit the overcirculation through the vascular bed.

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29
Q

TGA Presentation of:

TGA with IVS

Why?

A

Cyanosis

No mixing

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30
Q

TGA is what % of all CHD ?

A

7.8%

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31
Q

Dabigatran - commercial name

A

DOAC= Direct oral anticoagulants-

Apixaban (Eliquis®)

Dabigatran (Pradaxa®)

Rivaroxaban (Xarelto®)

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32
Q

What is the level of evidence for:

Mitral valve surgery is recommended for symptomatic patients with chronic severe primary MR (stage D) and LVEF greater than 30%

A

IB

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33
Q

what is the level of evidence for:

Mitral valve surgery is recommended for asymptomatic patients with chronic severe primary MR and LV dysfunction (LVEF 30% to 60% and/or left ventricular end-systolic diameter [LVESD] ≥40 mm, stage C2

A

IB

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34
Q

what is the level of evidence for

Mitral valve repair is recommended in preference to MVR when surgical treatment is indicated for patients with chronic severe primary MR limited to the posterior leaflet

?

A

IB

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35
Q

What is the level of evidence

Mitral valve repair is recommended in preference to MVR when surgical treatment is indicated for patients with chronic severe primary MR involving the anterior leaflet or both leaflets when a successful and durable repair can be accomplished (84,89,95,100–104).

A

IB

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36
Q

Class IB recomendations for MR

how many are there?

what are they?

A

There are 5 class IB recs

  1. Mitral valve surgery is recommended for symptomatic patients with chronic severe primary MR (stage D) and LVEF greater than 30%
  2. Mitral valve surgery is recommended for asymptomatic patients with chronic severe primary MR and LV dysfunction (LVEF 30% to 60% and/or left ventricular end-systolic diameter [LVESD] > 40 mm,
  3. Mitral valve repair is recommended in preference to MVR when surgical treatment is indicated for patients with chronic severe primary MR limited to the posterior leaflet
  4. Mitral valve repair is recommended in preference to MVR when surgical treatment is indicated for patients with chronic severe primary MR involving the anterior leaflet or both leaflets when a successful and durable repair can be accomplished
  5. Concomitant mitral valve repair or MVR is indicated in patients with chronic severe primary MR undergoing cardiac surgery for other indications (105).
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37
Q

What is the level of reccomendations for:

Mitral valve repair is reasonable for asymptomatic patients with chronic severe nonrheumatic primary MR (stage C1) and preserved LV function (LVEF >60% and LVESD <40 mm) in whom there is a high likelihood of a successful and durable repair with 1) new onset of AF or 2) resting pulmonary hypertension (pulmonary artery systolic arterial pressure >50mm Hg) ?

A

IIaB

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38
Q

What is the level of recomendation for

Concomitant mitral valve repair or MVR is indicated in patients with chronic severe primary MR undergoing cardiac surgery for other indications

?

A

IB

39
Q

what is the level of recomendation for:

Concomitant mitral valve repair is reasonable in patients with chronic moderate primary MR (stage B) when undergoing cardiac surgery for other indications.

A

IIaC

40
Q

what is the level of reccomendation for

Mitral valve surgery may be considered in symptomatic patients with chronic severe primary MR and LVEF less than or equal to 30%

?

A

IIaC

41
Q

what are the IIaB recomendation for mitral reccomendations

A

Just one, new, and for asymptomatic and specifies non-rheumatic

  1. Mitral valve repair is reasonable for asymptomatic patients with chronic severe nonrheumatic primary MR (stage C1) and preserved LV function (LVEF >60% and LVESD <40 mm) in whom there is a high likelihood of a successful and durable repair with 1) new onset of AF or 2) resting pulmonary hypertension (pulmonary artery systolic arterial pressure >50mm Hg)
42
Q

Class IIa reccomendations for Mitral regurgitaion ?

A

IIa B

  1. Repair is reasonable for asymptomatic patients with _chronic severe nonrheumatic primary MR (_stage C1) and:
    1. preserved LV function (LVEF >60% and LVESD <40 mm)
    2. a high likelihood of a successful and durable repair
    • with
    1. new onset of AF
    2. resting pulmonary hypertension (pulmonary artery systolic arterial pressure >50mm Hg)

IIa C

  1. Concomitant mitral valve repair is reasonable in patients with chronic moderate primary MR (stage B) when undergoing cardiac surgery for other indications.
  2. Mitral valve surgery may be considered in symptomatic patients with chronic severe primary MR and LVEF less than or equal to 30%
43
Q

What are the IIaC reccomendations for MR ?

A

IIa C

  1. Concomitant mitral valve repair is reasonable in patients with chronic moderate primary MR (stage B) when undergoing cardiac surgery for other indications.
  2. Mitral valve surgery may be considered in symptomatic patients with chronic severe primary MR and LVEF less than or equal to 30%
44
Q

what are the class II recomendations for mitral regurgitaion

A

IIa B

  1. Mitral valve repair is reasonable for asymptomatic patients with chronic severe nonrheumatic primary MR (stage C1) and preserved LV function (LVEF >60% and LVESD <40 mm) in whom there is a high likelihood of a successful and durable repair with 1) new onset of AF or 2) resting pulmonary hypertension (pulmonary artery systolic arterial pressure >50mm Hg)

IIa C

  1. Concomitant mitral valve repair is reasonable in patients with chronic moderate primary MR (stage B) when undergoing cardiac surgery for other indications.
  2. Mitral valve surgery may be considered in symptomatic patients with chronic severe primary MR and LVEF less than or equal to 30%

IIb B

Transcatheter mitral valve repair may be considered for severely symptomatic patients (NYHA class III to IV) with chronic severe primary MR (stage D) who have favorable anatomy for the repair procedure and a reasonable life expectancy but who have a prohibitive surgical risk because of severe comorbidities and remain severely symptomatic

despite optimal GDMT for heart failure (HF) (124).

45
Q

CV conditions which require abx prophylaxis at the dentist (5) ?

A

in patients with the following:

  1. Prosthetic cardiac valves, including transcatheter implanted prostheses and homografts.
  2. Prosthetic material used for cardiac valve repair, such as annuloplasty rings and chords.
  3. Previous IE.
  4. Unrepaired cyanotic congenital heart disease
  5. Repaired congenital heart disease, with residual shunts or valvular regurgitation at the site of or adjacent to the site of a prosthetic patch or prosthetic device.
  6. Cardiac transplant with valve regurgitation due to a structurally abnormal valve.
46
Q

What dental procedures require ppx for endocarditis?

A

Dental procedures that involve:

  • manipulation of gingival tissue
  • manipulation of the periapical region of teeth
47
Q

Apixaban - brand name

A

DOAC= Direct oral anticoagulants-

Apixaban (Eliquis®)

Dabigatran (Pradaxa®)

Rivaroxaban (Xarelto®)

48
Q

Eliquis® - generic name

A

DOAC= Direct oral anticoagulants-

Apixaban (Eliquis®)

Dabigatran (Pradaxa®)

Rivaroxaban (Xarelto®)

49
Q

Pradaxa - generic name

A

DOAC= Direct oral anticoagulants-

Apixaban (Eliquis®)

Dabigatran (Pradaxa®)

Rivaroxaban (Xarelto®)

50
Q

Rivaroxaban

A

DOAC= Direct oral anticoagulants-

Apixaban (Eliquis®)

Dabigatran (Pradaxa®)

Rivaroxaban (Xarelto®)

51
Q

Xarelto- generic name

A

DOAC= Direct oral anticoagulants-

Apixaban (Eliquis®)

Dabigatran (Pradaxa®)

Rivaroxaban (Xarelto®)

52
Q

Stage A valvular heart Disease

A

A: At risk Patients with risk factors for development of VHD

53
Q

Stage B heart valve disease

A

B: Progressive Patients with progressive VHD (mild-to-moderate severity and asymptomatic)

54
Q

Stage C valvualr heart disease ?

A

Stage C : Asymptomatic severe

Asymptomatic patients who have the criteria for severe VHD:

C1: Asymptomatic patients with severe VHD in whom the left or right ventricle remain compensated

C2: Asymptomatic patients with severe VHD, with decompensation of the left or right ventricle

55
Q

Stage C1 heart valve disease :

A

Stage C1: Asymptomatic patients with severe VHD in whom the left or right ventricle remain compensated

56
Q

Stage C2 heart valve disease ?

A

C2: Asymptomatic patients with severe VHD, with decompensation of the left or right ventricle

57
Q

Stage D heart valve disease

A

Symptomatic severe patients who have developed symptoms as a result of VHD

58
Q

2017 Revised Valve Guidelines

1A Recomendations for AVR

A

Surgical AVR or TAVR is recommended for symptomatic patients with severe AS (Stage D) and high risk for surgical AVR, depending on patientspecific procedural risks, values, and preferences

59
Q

what is the level of recomendation for ?

Surgical AR is recommended for symptomatic patients with severe AS (Stage D)

A

I-B-NR

60
Q

Aortic stenosis

  • severe - high gradient
  • symtoms on history.
A

1B reccomendation

AVR is recommended for symptomatic patients with severe high-gradient AS who have symptoms by history or on exercise testing (stage D1)

61
Q

Aortic Stenosis

severe, high grade stenosis

symptoms on exercise testing

A

1B reccomendation

Surgery -AVR is recommended for symptomatic patients with severe high-gradient AS who have symptoms by history or on exercise testing (stage D1)

62
Q

Reccomendation for a patient with:

severe AS (Stage c2)

No Symptoms

and an LVEF of < 50%

A

Surgery - 1B reccomendation

AVR is recommended for asymptomatic patients with severe AS (stage C2) and LVEF <50%

63
Q

Aortic Stenosis

ACC/AHA Class 1B reccomendations (4)

A
  1. AVR is recommended for symptomatic patients with severe high-gradient AS who have symptoms by history or on exercise testing (stage D1)
  2. AVR is recommended for asymptomatic patients with severe AS (stage C2) and LVEF <50%
  3. AVR is indicated for patients with severe AS (stage C or D) when undergoing other cardiac Surgery
  4. AVR is reasonable for asymptomatic patients with very severe AS (stage C1, aortic velocity 5.0 m/s) and low surgical risk
64
Q

Reccomendation for

asymptomatic patient

with an aortic velocity of 6.0 m/s

A

Class IB Reccomendation

  1. AVR is reasonable for asymptomatic patients with very severe AS (stage C1, aortic velocity 5.0 m/s) and low surgical risk
65
Q

Reccomendation for a patient

asymptomatic patients at baseline but decreased exercise tolerance

severe AS on ECHO

A

Class IIB reccomendation

AVR is reasonable in asymptomatic patients (stage C1) with severe AS and decreased exercise tolerance or an exercise fall in BP

66
Q

Reccomendtion for asymptomatic patient

with very severe AS

A

if the patient:

a. Decreased systolic opening of a calcified valve;
b. An aortic velocity 5.0 m per second or greater or mean pressure gradient 60 mm Hg or higher;
c. A low surgical risk

then surgery IIA

67
Q

Criteria for Aortic Valve Stenosis with low-flow/low gradient severe AS with reduced LVEF

A
  1. AVR is reasonable in symptomatic patients with low-flow/low gradient severe AS with reduced LVEF
    1. Baseline characteristics set up:
      1. Valve structure:
        1. Calcified aortic valve with reduced systolic opening;
        2. Resting valve area 1.0 cm2 or less;
      2. LV Function:
        1. LVEF less than 50%
      3. Hemodynamics
        1. velocity less than 4.0 m/s
        2. mean pressure gradient less than 40mmHg;
    2. Low-dose dobutamine stress study
      1. aortic velocity >=4.0m/s
      2. mean pressure gradient >=40 mmHg or higher
      3. with a valve area =< 1.0 cm2
      4. at any dobutamine dose.
68
Q

What is the level of reccomendation:

  1. AVR is reasonable in symptomatic patients with low-flow/low gradient severe AS (stage D3) with:
    1. an LVEF 50% or greater
    2. a calcified aortic valve with significantly reduced leaflet motion
    3. a valve area 1.0 cm2 or less only if clinical, hemodynamic, and anatomic data support valve obstruction as the most likely cause of symptoms and data recorded when the patient is normotensive (systolic BP <140 mm Hg) indicate (Level of Evidence: C):
      1. An aortic velocity less than 4.0 m per second or mean pressure gradient less than 40 mm Hg;
      2. A stroke volume index less than 35 mL/m2; and
      3. An indexed valve area 0.6 cm2/m2 or less.
A

IIA

69
Q

when should Aspirin be stopped preoperatively?

A

it shouldnt - cotinue through surgery

70
Q

tirofiban

what is it?

when should it be stopped preoperatively?

A
  1. tradename: Aggrastat: short-acting glycoprotein IIb/IIIa inhibitors
  2. when to stop?
    1. can be stopped 2-4 hours before surgery.
71
Q

eptifibatide

what is it?

when should it be stopped preoperatively?

A
  1. short-acting glycoprotein IIb/IIIa inhibitors
  2. when to stop?
    1. can be stopped 2-4 hours before surgery.
72
Q
  1. Abciximab
    1. ​what is it?
    2. when is stopped preoperatively
A
  1. Abciximab
    1. longer-acting glycoprotein IIb/IIIa inhibitor
    2. when to stop preoperatively ?

can be stopped 12 hours before surgery

73
Q

Prasugrel

what is it?

when should it be stopped preoperatively

A
  1. Prasugrel should be held for at least 7 days before surgery.

Prasugrel

(trade name Effient in the US and India, and Efient in the EU)

an irreversible anatagonist of P2Y12ADP receptors

74
Q

What is the Level of evidenc for :

asymptomatic patients with severe AS (Stage C) who meet an indication for AVR when surgical risk is low or intermediate?

A

I-B-NR

75
Q

Reccomendations for use of COX-2 inhibitors for analgesia following CABG surgery

A

Class III (Harm) B

76
Q

Reccomendations for the use of IMA (left or right) in bypassing the LAD

A

Class I B

If possible, the left internal mammary artery (LIMA) should be used
to bypass the left anterior descending (LAD) artery when bypass of
the LAD artery is indicated

Class IIA

The right internal mammary artery (IMA) is probably indicated to
bypass the LAD artery when the LIMA is unavailable or unsuitable as
a bypass conduit.

77
Q

Reccomendations for use of a second IMA ?

A

IIa (B)

When anatomically and clinically suitable, use of a second IMA to graft the:

left circumflex

or

right coronary artery (when critically stenosed and perfusing LV myocardium)

is reasonable to improve the likelihood of survival and to decrease reintervention

78
Q

ACC/AHA Recomendations for the use of IMA to graft to the right coronary artery

A

IIa ( AHA/ACC 2011)

right coronary artery (when critically stenosed and perfusing LV myocardium)

79
Q

2011 ACC/AHA Reccomendations for complete arterial revascularization

A

IIb (C) - 2011

Complete arterial revascularization may be reasonable in patients
less than or equal to 60 years of age with few or no comorbidities

80
Q

2011 ACC/ AHA recomendations for arterial grafting to the right

A

IIb (B) - 2011

Arterial grafting of the right coronary artery may be reasonable
when a critical (90%) stenosis is present

81
Q

2011 ACC/AHA Recomendation for the use of a RADIAL artery

A

IIb (B) - 2011

Use of a radial artery graft may be reasonable when:

grafting left-sided coronary arteries with severe stenoses (70%)

and

rightsided arteries with critical stenoses (90%) that perfuse LV myocardium

82
Q

Class III Reccomendations for using artery bypass conduit

A

An arterial graft should not be used to bypass the right coronary
artery with less than a critical stenosis (90%)

83
Q

2011 ACC AHA reccomendations for ischemic conditioning

A

II B

  1. The effectiveness of prophylactic _pharmacological_ therapies or controlled reperfusion strategies aimed at inducing preconditioning or attenuating the adverse consequences of myocardial reperfusion injury or surgically induced systemic inflammation is uncertain(182–189). (Level of Evidence: A)
  2. Mechanical preconditioning might be considered to reduce the risk of perioperative myocardial ischemia and infarction in patients undergoing off-pump CABG (190–192). (Level of Evidence: B)
  3. Remote ischemic preconditioning strategies using peripheralextremity occlusion/reperfusion might be considered to attenuate the adverse consequences of myocardial reperfusion injury (193– 195). (Level of Evidence: B)
  4. The effectiveness of postconditioning strategies to attenuate the adverse consequences of myocardial reperfusion injury is uncertain
84
Q

2013 ACC/AHA Broad Definition of NSTEMI Syndrome

A

clinical syndrome defined by:

Characteristic symptoms of myocardial ischemia in association with:

Persistent electrocardiographic (ECG) ST elevation

85
Q
  • 2013 ACC AHA guidelines for ST - ECG changes necessiry for STEMI Diagnosis
  • generic definition
A

ST- ELEVATION

new ST elevation at the J point in at least 2 contiguous leads

2 mm (0.2 mV) in men or 1.5 mm (0.15 mV) in women in leads V2–V3

and/or

1 mm (0.1mV) in other contiguous chest leads or the limb leads

86
Q

ST depression in 2 precordial leads (V1–V4);

A

ACC/AHA 2013 STEMI Recs

ST depression in 2 precordial leads (V1–V4) may indicate:

transmural posterior injury;

87
Q

multilead ST depression with

coexistent ST elevation in lead aVR

A

multilead ST depression with coexistent ST elevation in lead aVR

has been described in patients with-

left main or proximal left anterior descending artery occlusion .

ACC/AHA 2013 STEMI Recs

88
Q

ACC/AHA 2013

if fibrinolytics are chosen as therapy when should they be used

A

Fibrinolytics shold be given within 30 minutes of arrival to the hospital

89
Q

ACC AHA 2013 - NSTEMI

Recomendation for reperfusion therapy (interventional) in the setting of a STEMI

A

Reperfusion therapy is reasonable for patients with:

STEMI

&

Symptom onset within 12-24 h who have clinical or ECG evidence of ongoiong ischemia

90
Q

Fondaparinux

A

Fondaparinux (trade name Arixtra) is an anticoagulant medication chemically related to low molecular weight heparins. It is marketed by GlaxoSmithKline. A generic version developed by Alchemia is marketed within the US by Dr. Reddy’s Laboratories.

ACC/AHA 2011 Class III Rec: should not be used as a sole anticoagulant to support PCI

91
Q

Class I Recomendations for CABG in the Setting of STEMI

A

AHA/ACC 2013 Class 1 Rec for STEMI

  1. Urgent CABG is indicated in patients with STEMI and coronary anatomy not amenable to PCI who have ongoing or recurrent ischemia, cardiogenic shock, severe HF, or other high risk features (Level of Evidence: B)
  2. CABG is recommended in patients with STEMI at time of operative repair of mechanical defects (Level of Evidence: B)
92
Q

Level of evidence for the use of MCS in patient with STEMI

A

ACC/AHA 2013

Class IIa Reccomendation:

Use of MCS is reasonable in patients with STEMI who are hemodynamically unstable and require CABG

93
Q

New York State Criteria

Cardiogenic Shock

A

Cardiogenic Shock:

  1. episode of systolic BP < 90mmHG
  2. CI < 2.2L / min/m2

determined to be secondary to cardiac dysfunction

and

the requirment for parenteral inotropic or vasopressor or MCS (IABP, VAD, ECMO) to maintainain BP above these levels

94
Q

Xarelto mechanism of action

A

Rivaroxaban

inhibits both free Factor Xa and Factor Xa bound in the prothrombinase complex.

ACC/AHA Guidelines (10 decks)

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