CAD

Question 1

Metabolic syndrome

Answer 1

3/5 criteria
Abdominal obesity (>= 102 cm men, >= 88 cm in men)
TG > 175
HDL < 40 men, < 50 women
BP > 130/85
Fasting glucose >= 100

Question 2

Indication for stress EKG in asymptomatic

Answer 2

CLass IIb

Intermediate risk, particularly when starting exercise program

Question 3

Indication for asymptomatic stress test with imaging

Answer 3

May be considered when DM, strong FH CHD, previous assessment suggests high risk such as CAC score > 400

Question 4

Very high risk ASCVD

Answer 4

History of ASCVD

>= 2 events or 1 events and >=2 conditions

Question 5

Events for ACSVD very high risk

Answer 5

ACS < 12 mo
h/o MI or stroke
Symptomatic PAD

Question 6

Conditions for ASCVD very high risk

Answer 6

Smoker, DM, HTN
LDL >= 100 on max therapy
>= 65
Heterozygous FH
h/o CABG or PCI
CKD GFR 15-59
CHF

Question 7

Very high risk ASCVD LDL goal

Answer 7

<70

Question 8

History of ASCVD, not very high risk LDL goal

Answer 8

Lower by 50%

Question 9

LDL >= 190, primary prevention goal

Answer 9

Lower by 50% or LDL < 100

Question 10

DM + ASCVD risk > 20% treatment

Answer 10

High intensity statin

Question 11

DM + ASCVD risk < 20% treatment

Answer 11

Look at risk enhancers
If yes -> high intensity
If not -> moderate

Question 12

DM risk enhancers for primary prevention

Answer 12

DM2 for 10 yrs, DM1 for 20 yrs
Ur albumin >= 30 mcg/mg creat
eGFR < 60
Retinopathy, neuropathy
ABI < 0.9

Question 13

LDL < 190, non-DM management age 0-19

Answer 13

Lifestyle

Statin if FH

Question 14

LDL < 190, non-DM management age 20-39

Answer 14

Lifestyle

If early ASCVD and LDL > 160 -> statin

Question 15

LDL < 190, non-DM management age 40-75

Answer 15

Risk calculator

Question 16

ASCVD risk >= 20% treatment

Answer 16

High intensity statin

Question 17

ASCVD risk <= 5%

Answer 17

Lifestyle

Question 18

ASCVD risk 5-20% treatment

Answer 18

Borderline, look at risk enhancers
If yes -> moderate statin
If uncertain and 7.5-20 -> CAC

Question 19

High intensity statin reduction

Answer 19

> =50%

Question 20

Moderate intensity statin reduction

Answer 20

30-50%

Question 21

Low intensity statin reduction

Answer 21

<30%

Question 22

Aspirin primary prevention indication

Answer 22

Class IIb

ASCVD > 20%, maybe >10%, not increased bleeding risk

Question 23

Duke treadmill score

Answer 23

Maximum exercise time in minutes - 5(ST segment deviation in mm) - 4(angina index)

Question 24

High risk duke treadmill score

Answer 24

<= - 10

Question 25

Low risk duke treadmill score

Answer 25

>= 5

Question 26

Class I for coronary angiography

Answer 26

High likelihood of severe CAD | Unacceptable symptoms despite GDMT

Question 27

High risk CAD (>3% risk of death or MI / year) at rest

Answer 27

EF < 35% >10% myocardium perfusion abnormality without prior history or evidence of MI Multivessel disease or LM 50% on CCTA

Question 28

High risk CAD (>3% risk of death or MI / year) on stress

Answer 28

>= 2 mm ST depression on stress EKG Stress induced LV dysfunction (EF < 45 or drop 10) 10% myocardium or multiple territory induced perfusion abn Stress induced LV dilatation Induced WMA >2 seg or 2 coronary beds WMA at low dose of dobutmaine <10 or HR <= 120

Question 29

AUC for coronary angiography

Answer 29

- Symptomatic with high pretest probability of CAD without stress test - Intermediate risk stress imaging - Discordant clinical and stress result - Equivocal / non-diagnostic stress - CCTA: symptomatic with >= 50% / possibly obstructive stenosis

Question 30

Class I for CABG in SIHD, improves survival

Answer 30

Left main 3VD 2VD with proximal LAD Post arrest with ischemia mediated VT

Question 31

Class IIa CABG in SIHD

Answer 31

1 vessel with proximal LAD

Question 32

Class IIa for FFR in SIHD

Answer 32

Intermediate lesions 50-70%

Question 33

Class I for PCI in SIHD

Answer 33

1+ significant stenosis, unacceptable angina despite GDMT (excluding improved survival with CABG)

Question 34

Low SYNTAX score

Answer 34

0-22

Question 35

Intermediate SYNTAX score

Answer 35

23-32

Question 36

High SYNTAX score

Answer 36

>33

Question 37

Class IIa LM PCI in SIHD

Answer 37

Low risk SYNTAX | STS >= 5%

Question 38

LM in SIHD treatment

Answer 38

``` CABG for most PCI in low risk and complexity class IIa ```

Question 39

3VD in SIHD treatment

Answer 39

CABG for most | PCI if low risk, SYNTAX <= 22, non-DM

Question 40

2VD in SIHD treatment

Answer 40

PCI or CABG

Question 41

1VD in SIHD treatment

Answer 41

PCI

Question 42

High risk MPI stress findings

Answer 42

- >12% myocardial defect - Severe reversible defect - Abnormal EF - Increased lung uptake of tracer - Transient ischemic dilation (TID)

Question 43

Duke treadmill score

Answer 43

Exercise duration (minutes) - (4 x angina index) - (5 x maximum ST deviation)

Question 44

Angina index

Answer 44

0 - no angina 1 - angina that doesn't limit exercise 2 - angina limiting exercise

Question 45

Low risk DTS

Answer 45

>= 5 | 5 year survival 97%

Question 46

Intermediate risk DTS

Answer 46

-10 to +4 | 90% 5 year survival

Question 47

High risk DTS

Answer 47

-11 or lower | 65% 5 year survival

Question 48

Strongest predictors of post-STEMI mortality

Answer 48

Age > 75 | SBP < 100

Question 49

Carotid duplex before CABG if

Answer 49

``` >65 L main PAD Smoking Stroke/TIA Carotid bruit ```

Question 50

Coronary flow reserve

Answer 50

For microvascular dysfunction | Ratio of intracoronary mean velocity with hyperemia / baseline

Question 51

CFR response to IC adenosine < 2.5

Answer 51

non-endothelial microvascular dysfunction

Question 52

CFR decreased coronary diameter in response to IC acetylcholine

Answer 52

macrovascular dysfunction 

Question 53

CFR increased coronary diameter in response to IC NG

Answer 53

non endothelial macrovascular dysfunction

Question 54

Atheroembolic embolization / cholesterol emboli

Answer 54

livedo reticularis, eosinophils in urine with renal dysfunction

Question 55

Cholesterol emboli management

Answer 55

Aggressive secondary prevention