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Cardiology > Acute Coronary Syndromes > Flashcards

Acute Coronary Syndromes Flashcards

1
Q

Stable angina

A

chest or arm discomfort brought on by exertion or emotional stress, relieved within 5-15 min by rest or ntg

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2
Q

anginal equivalents

A

women/diabetes/elderly

dyspnea, nausea, fatigue faitness

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3
Q

MI Classification

A

type 1- spontaneous- plaque rupture
type 2- MI secondary to imbalance- spasm, pul embolism, anemia
type 3- sudden unexpected cardiac death before biomarkers
type 4- a. ass. PCI b. stent thrombosis
type 5- MI ass with CABG

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4
Q

integrelin

A

eptifibatide
must be adjusted for renal
CrCl <50, decrease infusion to 1mcg/kg/min
max 7.5mg/hr

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5
Q

stemi platelet function:

A

adhesion- mediated by vWF
activation- adp (thrombin induced)- express GP 2b3a
aggregation- fibrinogen links platelet
amplifications

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6
Q

ntg contraindications

A

hypotensive
severe aortic stenosis
rv infarction
pde for ed <24 hrs

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7
Q

UA/NSTEMI class 3

A 
thrombolytic rx
nitrates if 100
iv ace in 1st 24 hr
iv b blocker if chf/ shock
NSAID
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8
Q

TIMI risk score

A

age 65, >3 risk factors, prior cad >50%, asa < 7 days, >2 angina events, st deviation, elevated markers

markers of highest risk st deviation and elevated markers

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9
Q

first step usa or nstemi

A

asa or clopidogrel if asa intolerant

prasugrel if going to pti strategy

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10
Q

Immediate angio/revascularization

A 
persistant ischemic discomfort p meds
hemo unstable
severe lv dysfuntion or chf
worsening mr or vsd
sustained vent arrhythmia
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11
Q

volume of contrast causing contrast induced nephropathy

A

volume/CrCl > 3.7 is high risk for CIN

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12
Q

diabetic revascularization

A

cabg with lima guideline preferred over pci with multivessel disease

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13
Q

normal coronary art with ua/nstmi

A 
9-14% 
mechanisms
thrombolysis on nonobstructive plaque
vasospasm
pul embolism, myocarditis, hypertensive emergency
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14
Q

platelet in acs

A

adhesion: collagen, vWF
activation: ADP (most important) thienopyridine/ ticagrelor (brilanta)
thrombin, and thromboxane
amplification:
aggregation: plt express Gp2b 3a receptor

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15
Q

ADP platelet therapy

A

thienopyridines (clopidogrel, prasugrel) irreversible P2Y12 receptor blocker for inhibiting ADP production
ticagrelor (reversible)

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16
Q

ASA action platlets

A

blocks tromboxin production

17
Q

Final pathway of platelet aggregation

A

GP 2b3a receptor
abciximab (repro)
eptifibatide (integrelin) irreversible
tirofiban (aggrastat)

18
Q

asa intolerant

A

clopidogrel, prasugril ( if invasive anticipated) or ticagrelor

19
Q

clopidogrel metabolism

A

drug in pro form:
needs to be oxidized 2x in liver: cyp 2c19
TRITON study

20
Q

prasugrel

A

pro drug: more efficient mechanism than clopidigrel in conversion
more efficient absorption-
1 oxidative step

21
Q

abciximab

A

guidelines only in cath lab

22
Q

platetet rx in ER

A

clopidigrel with load or
2b3a inhibitor (eptifibatide, tirofaban)
integrlin or aggrastat (repro (abciximab) in labs)
at time of pci: clopidigrel, prasugrel or 2b3a

23
Q

bleeding with prasugrel

A 
triton timi 38
groups @ higher risk
tia/cva hx
age >75 yo
wt < 60kg
24
Q

prasugrel contraindication

A

prior stroke or tia

25
Q

ticagrelor

A

brilanta- p2y12 receptor like clopidigrel/prasugrel
but not pro drug and irreversible
depends on plasma concentration
plasma concentration takes 3-5 days for platelet activity
side effects: dry cough, and mild dyspnea, brady

26
Q

anti-platelet rx washout for cabg

A

clopidigrel - 5-7 days
ticagrelor- 5 days
prasugrel- 7-10 days

27
Q

GB2b3a inhibitors

A

abciximab (repro) monoclonal ab- irreversible blocker
not upstream use
eptifibatide (integrelin) reversible, but longer t1/2, needs renal adjustment
tirofiban (aggrastat) reversible

28
Q

bivalrudin

A

direct antithrombin

rx alone with low bleeding risk

29
Q

prior to cabg- antithrombotic recs

A

no not stop ufh (continue)
dc eptifabatide >4hr prior to cabg
dc clopidogrel >5 day prior to cabg
dc prasugrel >7 d prior to cabg

30
Q

triple antithrombotic rx

A 
use lowest asa dose
standard clopidogrel dose
inr 2.0-2.5
ppi rx prophylactically
stop asa if risk high, bare metal stents
31
Q

MI mimics:

A

dissection, pericarditis, myocarditis, pul embolism, pneumothorax

32
Q

Contraindication for thrombolytics:

A

hx of intracranial hemorrhage, vascular cerebral avm or neoplasm,
cva <3 mths, aortic dissection, bleeding, closed head, facial trauma

33
Q

DES STEMI benefits

A

only decreases revasc <1yr

34
Q

STEMI thrombus PCI

A

Aspiration benefit, protection no benefit

35
Q

Occluded PTCA

A 
>23 hr class 3 indication
OAT trail with increased mortality
36
Q

STEMI b blockers

A 
iv b blocker class 3 if signs of hypo-perfusion and chf
oral b blockers better
37
Q

STEMI theiopyridines

A

no prasugrel if previous cva or tia

38
Q

lytic therapy and ADP rx

A

prasugrel not recommended - not tested

39
Q

anticoag > 48 hr

A

avoid UFH

enaxaparin, fundaparin used

Cardiology (15 decks)

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