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Cardiology Boards > CAD > Flashcards

CAD Flashcards

1
Q

Metabolic syndrome

A 
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
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2
Q

Indication for stress EKG in asymptomatic

A

CLass IIb

Intermediate risk, particularly when starting exercise program

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3
Q

Indication for asymptomatic stress test with imaging

A

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

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4
Q

Very high risk ASCVD

A

History of ASCVD

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

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5
Q

Events for ACSVD very high risk

A

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

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6
Q

Conditions for ASCVD very high risk

A 
Smoker, DM, HTN
LDL >= 100 on max therapy
>= 65
Heterozygous FH
h/o CABG or PCI
CKD GFR 15-59
CHF
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7
Q

Very high risk ASCVD LDL goal

A

<70

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8
Q

History of ASCVD, not very high risk LDL goal

A

Lower by 50%

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9
Q

LDL >= 190, primary prevention goal

A

Lower by 50% or LDL < 100

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10
Q

DM + ASCVD risk > 20% treatment

A

High intensity statin

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11
Q

DM + ASCVD risk < 20% treatment

A

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

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12
Q

DM risk enhancers for primary prevention

A 
DM2 for 10 yrs, DM1 for 20 yrs
Ur albumin >= 30 mcg/mg creat
eGFR < 60
Retinopathy, neuropathy
ABI < 0.9
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13
Q

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

A

Lifestyle

Statin if FH

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14
Q

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

A

Lifestyle

If early ASCVD and LDL > 160 -> statin

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15
Q

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

A

Risk calculator

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16
Q

ASCVD risk >= 20% treatment

A

High intensity statin

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17
Q

ASCVD risk <= 5%

A

Lifestyle

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18
Q

ASCVD risk 5-20% treatment

A

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

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19
Q

High intensity statin reduction

A

> =50%

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20
Q

Moderate intensity statin reduction

A

30-50%

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21
Q

Low intensity statin reduction

A

<30%

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22
Q

Aspirin primary prevention indication

A

Class IIb

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

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23
Q

Duke treadmill score

A

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

24
Q

High risk duke treadmill score

A

<= - 10

25
Q

Low risk duke treadmill score

A

> = 5

26
Q

Class I for coronary angiography

A

High likelihood of severe CAD

Unacceptable symptoms despite GDMT

27
Q

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

A

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

28
Q

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

A

> = 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

29
Q

AUC for coronary angiography

A
  • 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
30
Q

Class I for CABG in SIHD, improves survival

A

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

31
Q

Class IIa CABG in SIHD

A

1 vessel with proximal LAD

32
Q

Class IIa for FFR in SIHD

A

Intermediate lesions 50-70%

33
Q

Class I for PCI in SIHD

A

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

34
Q

Low SYNTAX score

A

0-22

35
Q

Intermediate SYNTAX score

A

23-32

36
Q

High SYNTAX score

A

> 33

37
Q

Class IIa LM PCI in SIHD

A

Low risk SYNTAX

STS >= 5%

38
Q

LM in SIHD treatment

A 
CABG for most
PCI in low risk and complexity class IIa
39
Q

3VD in SIHD treatment

A

CABG for most

PCI if low risk, SYNTAX <= 22, non-DM

40
Q

2VD in SIHD treatment

A

PCI or CABG

41
Q

1VD in SIHD treatment

A

PCI

42
Q

High risk MPI stress findings

A
  • > 12% myocardial defect
  • Severe reversible defect
  • Abnormal EF
  • Increased lung uptake of tracer
  • Transient ischemic dilation (TID)
43
Q

Duke treadmill score

A

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

44
Q

Angina index

A

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

45
Q

Low risk DTS

A

> = 5

5 year survival 97%

46
Q

Intermediate risk DTS

A

-10 to +4

90% 5 year survival

47
Q

High risk DTS

A

-11 or lower

65% 5 year survival

48
Q

Strongest predictors of post-STEMI mortality

A

Age > 75

SBP < 100

49
Q

Carotid duplex before CABG if

A 
>65
L main
PAD
Smoking
Stroke/TIA
Carotid bruit
50
Q

Coronary flow reserve

A

For microvascular dysfunction

Ratio of intracoronary mean velocity with hyperemia / baseline

51
Q

CFR response to IC adenosine < 2.5

A

non-endothelial microvascular dysfunction

52
Q

CFR decreased coronary diameter in response to IC acetylcholine

A

macrovascular dysfunction

53
Q

CFR increased coronary diameter in response to IC NG

A

non endothelial macrovascular dysfunction

54
Q

Atheroembolic embolization / cholesterol emboli

A

livedo reticularis, eosinophils in urine with renal dysfunction

55
Q

Cholesterol emboli management

A

Aggressive secondary prevention

Cardiology Boards (11 decks)

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