CAD

Question 1

Patient is 2 days post inferior wall MI and is in cardiogenic shock with crackles in lung bases and no murmur on exam. Most likely diagnosis?

Answer 1

Papillary wall rupture.

RV infarct would not have clear lung bases.

Ventricular septal rupture more common in anterior wall MI

Question 2

What is the first line drug in patient with STEMI and AFib RVR?

Answer 2

Beta blockers

CCB May be given if contraindication to BB such as wheezing.

Question 3

In a patient with ACS and established history of HIT, what is the preferred anti-coagulant?

Answer 3

Bivalirudin

Fondaparinux may also be used but has been associated with higher rates of catheter thrombus at time of PCI

Question 4

First line therapy in isolated hypertriglyceridemia?

Answer 4

Fenofibrate or Niacin

Question 5

What is the correct order of events in the ischemic cascade?

Answer 5

Perfusion defects —> diastolic dysfunction —> systolic dysfunction —> EKG changes —> Chest pain

Question 6

Pressure waves:

Answer 6

Constriction: rapid X and Y descent

Tamponade: rapid X descent

Restriction: rapid Y descent

TR: No X or Y descent. Prominent V wave

Question 7

Diastology Echo values:

Answer 7

Abnormal values:
E’ lateral < 10
E’ septal < 7
E/e’ > 14
LA volume > 34
TR vmax > 2.8m/s
MV E/A ratio <0.8 or > 2.0

Question 8

What are significant values for iFR and FFR?

Answer 8

IFR: < or = 0.89

FFR: < or = 0.80