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cardio RC > CAD + HF > Flashcards

CAD + HF Flashcards

1
Q

Ischemia 2018 study regarding conservative vs invasive strategy

A

no difference in all cause mortality but CV death was lower

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2
Q

CAPRIE trial study regarding clopidogrel

A

as SAPT :
- showed reduced MAJOR ADVERSE CARDIOVASCULAR EVENTS (MACE) with clopidogrel over ASA in patients with
* CAD/
* Stroke/
* PAD

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3
Q

HOST EXAM STUDY ( CIRCULATION 2023)

A

Showed lower rates of cardiovascular death, MI, stroke and bleeding with long term clopidogrel compared to ASA after 1 year of DAPT post PCI (12.8% vs 16.9%)

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4
Q

CCB when to avoid as an antianginal and which subtype reduces preload

A
  1. if EF <40%
  2. dihydropyridine
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5
Q

WHich antianginal reduces LVEDP?

A

nitrate

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6
Q

name the disease modifying therapies in CAD

A
  1. BB
  2. AceI
  3. SGLT2/GLP1
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7
Q

in what context does BB not reduce MACE ?

A

*If no previous MI and LVEF >50 = use of BB therapy does not ↓ MACE, in absence of other indication for BB (eg for control of HTN or rapid afib

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8
Q

compass trial results implies what ?

A

low dose ASA + rivaroxaban 2.5 mg BID
- Another option for secondary prevention in patients with chronic stable CAD
- another alternative to patient with CAD + AF at low risk stroke ( CHads65=0)

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9
Q

Post PCI trial rsults says what about routine stress test

A
  • don’t need to do routine stress testing after a year : no differences in all cause death, MI or hospitalization for angina with surveillance strategy on routine stress testing
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10
Q

Indication for CABG

A
  1. Left main disease >50% occulusion
  2. Multisystem disease + LV dysfunction/HF
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11
Q

benefiits of CABG

A

less repeat revascularisation
Better survivial
unknown stroke

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12
Q

invasive angio for?

A
  • high risk features on non invasive test
  • refractory to medical tx
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13
Q

post MI complication

A
  • HF
  • Arrythmias
    o Tachy ( atrial/vent)
    o Brady ( Heart block especially if inf MI)
  • Mechanical complications
    o Pap msc dysfunction & acute MR
    o Ventricular septal rupture
    o Free wall rupture
    o RV infarction ( esp inferior)
  • Pericarditis
    o Post MI pericarditis = early (±5d) vs delayed ( dressler ; 2-8weeks)
    o Fever, pl CP, rub, effusion tx = high dose ASA + colchicine
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14
Q

ticagrelor contraindicaiton

A

o IC hmrg
o Active patho bleeding
o Hepatic impairment
o Combinations with CYP34A inhibitors ( ketoconazole, clarithromycin, ritonavir)
o Avoid if evidence of brady/ Heart block

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15
Q

prasugrel CI

A

o Active bleeding
o Prior TIA/stroke ( even if ischemic stroke)
o Hypersensitivity rxn

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16
Q

in fibrinolysis/thrombolysis, what’s your antiplatelet cocktail and why

A

ASA and clopidogel, because not studied (tica & prasu)

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17
Q

tica vs prasu, which one would you not give if have bradycardia/heart blog

A

tica

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18
Q

tica vs prasu, which one would not give if hepatic impairment

A

tica

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19
Q

tica vs prasu, which one would not give if prior stroke ( regardless s

A

prasu

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20
Q

prefered antiplatelet

A

ticagrelor

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21
Q

right atrial 2023 study said what about anticoagulation post PCI

A

48H post PCI anticoagulation in STEMI showed no difference in death, MI , stroke ,r evascularization, stent thrombosis

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22
Q

how long do you continue anticoagulation and when do you stop

A

for at least 48 hours or until discharge or max 8 days or stop once revascularized

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23
Q

when do you start beta blockers in CAD

A

within 24 hours in stable patients

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24
Q

why tica prefered vs clopidogrel

A

-greater efficiency
-no increased bleedidng risk

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25
Q

hold p2yi pre CABG how long

A

2-7 days per op

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26
Q

stable CAD with AF - what does the AFIRE trial say

A

rivaroxaban +ASA had more bleeding with nor eduction on ischemic events compared to rivaroxaban alone. thus OAC monotherapy is prefered

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27
Q

high bleeding risk patients, name the major bleeding risk

A
  1. advanced ckd
  2. cirrhosis + portal htn
  3. active malignancy ( except melanoma) in last 12 month and underoging tx
  4. spontaenous bleeding with hospit or transfusion in last 6 month or anytime if recurrent;chronic bleeding diathesis
  5. hgb <110, thrombocytopenia w/ plt <100
  6. prior spontaneous/traumatic ICH <12 month
  7. brain avm/stroke <6month
  8. anticipated use of longterm anticoag ( exclusiding compass riva trial )
  9. non deferable major surgery on DAPT
  10. Recent major surgery/trauma <30days before PCI
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28
Q

minor bleeding risk patient

A

2 minor
- moderate CKD
- spontaenous bleeding wtih hospitalization or transfusion <12month not meeting major criterion
- hgb 110-129 for men / 110-119 women.
- any ishcemic stroke not meeting major criterion
- long term NSAID/steroids
- age >75

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29
Q

complex pci - name what could it be

A
  1. left main
  2. 3 vx
  3. 3 lesions
  4. 3 stents
  5. > 60 mm stent
  6. bifurcation stents
  7. bypass graft PCI
  8. atherectomy/CTO procedure
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30
Q

what does the combinatiton of ASA-statin-ramipril do per the SECURE trial

A

reudces MACE and imrpoves adherence

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31
Q

PCI in what case if person has diabetes with LM

A

in the case of low intermediate complexity CAD , could consider it as an alternative to CABG

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32
Q

if thrombolysis in ACS - what P2Y12 do you avoid

A

Prasu & tica

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33
Q

do you stop anticoag if revasc ?

A

yes !

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34
Q

per right trial, point of extending anticoag 48H post PCI ?

A

none !

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35
Q

if fibrinolysis, how quickly does it need to happen

A

30 min

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36
Q

if fibrinolysis, pci should occur when ?

A

within 24H

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37
Q

max timing for fibrinolysis

A

24H

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38
Q

CI to fibrinolysis for stemi

A

HABITS
- hmrg ( IC, ever)
- aortic dissection
- bleeding ( diathesis, active)
- IC (lesion/malignancy)
- T ( trauma, closed headed)
- STROKE ( ischemic w/in 3 months)

39
Q

what do load a patient with when doing lysis ?

A

clopidogrel

40
Q

can you give tica or prasu post lysis

A

yes

41
Q

early invasive strategy within 48H in NSTEMI improves what ? any mortality benefit ?

A

reduces risk of rehospit for ACS
no mortality benefit

42
Q

post ACS DAPT

A

-DAPT 12 months : ASA + tica/prasu
- after 1 year; if high risk –> sapt, if low risk –> ad 3 years

43
Q

post ACS DAPT in high bleeding risk ?

A

DAPT or 3 months and descalate to SAPT after 1-3 months or to a less potentent 2nd antiplt ( change to asa + clopido)

44
Q

post elective PCI stent ? what do you do
- high risk bleed
- low risk bleed

A

high risk. bleed
*DES : 3 months DAPT –> SAPT 4eva
*BMS : 1 month DAPT –> SAPT 4 eva

low risk bleed
DAPT x 6M –> if high risk thromobotic risk –> 3 years

45
Q

medically managed ACS, which p2y1?

A
  • Tica >clopido > prasu
46
Q

whend o you give second antiplatelet in ACS acutely ?

A

STEMI

47
Q

postop CABG
- off pump tx
- onb pump tx
- afib

A
  • DAPT : ASA+tica/prasu
  • SAP
  • OAC
48
Q

sglt2 inhib reduce what in CAD?

A

MACE

49
Q

empact mi and dapa mi : sglt2 post mi …… what did they say

A

post mi without db w/ lv dysfunction or hf - did not reduce death or mace . so no routine sglt2 post MI

50
Q

influenza vaccination post MI ?

A

Influenza vaccine administered within 72 hours
post STEMI/NSTEMI reduced all cause mortality, MI, stent thrombosis at 12 months compared to placebo

51
Q

allergens causing coro vasospasms in context of minoca

A

kounis syndrome

52
Q

who do you want to consider for invasive coro in hf

A
  1. HF + sx
  2. EF <35% + risk factors CAD
  3. Systolic HF + evidence on non invasive coro perfusion testing
53
Q

how quickly to establish diagnosis of acute HF in ED ?

A

<2hrs

54
Q

timing of echo in acute HF ?

A

48hrs

55
Q

3 ddx of acute pulmonary edema

A
  • htn
  • mr
  • arrythmia
56
Q

if hypertensive or MR and have acute pulmo edema, what to give ?

A

short acting VD ( nitro spray/infusion/patch)

57
Q

if soft bp, acute hf, atrial arrythmia, what meds can you use to help control rate ?

A

digoxin

58
Q

the use of validated score to see if admission or outpatient management was associated with what ?

A

decreased overall death and decreases hospit

59
Q

why do we use BNP in HF ?

A
  1. if dx uncertain
  2. prognosis
60
Q

per sodium hf trial 2022, strict salt restriction improves HF related hospit visit or cv death ?

A

no

61
Q

between CABG and PCI in ischemic cardiomyopathy options for revascularization, which one would lead to improvced outcomes ? what remains paramount regardless

A

CABG !!!
optimizing medical therapy

62
Q

BB in hfref , in what case ?

A

euvolemic and hmd stable

63
Q

if ef <40%, what meds to avoid ( except which one in that category)

A

ccb. amlodipine in HTN

64
Q

NYHA 4 patients - candidate for BB ?

A

no

65
Q

ARNI post acei wash out period time ? why ?

A

36 hours
avoid bradykinin–> angioedema

66
Q

when do you start considering device therpay options
- NYHA
- EF
- amb/hospit ?

A

NYHA 1-4
EF <35%
ambulatory

67
Q

when do you start considering HF advanced therapy , advanced care plan, palliation

A

NYHA 3-4
high risk
Advanced HF

68
Q

requirement to start ivabradine

A
  • being in sinus rhythm
  • if hospit in last year for CHF + HR > 70
69
Q

ARNI CI

A
  1. familial/idiopathic angioeedema
70
Q

Victoria trial looked at what ?

A

the vericiguat initiation in EF < 45 % with recent hospitalisation which showed a 10% decrease in CV deaht & HF hospit

71
Q

primary prevention devices after how long ? ( considerd appropriate)

A

3M OMT
3M post revasc
40D after MI

72
Q

CCS HF guideline in terms of who should get an ICD

A

ICM, NYHA 2-4 , EF <35%
ICM , NYHA 1 , EF <30%
NICM, NYHA 2-3, EF <35%

73
Q

ICD 2nd prevention for who ( ischemic and non ischemic populatiobn)

A
  1. Cardiac arrest ( VT/VF)
  2. Sust VT in prescence of significant SHD
  3. sust VT >48H post MI/revasc
74
Q

which ICD for 2nd prevention is able to pace : trasV or subcut

A

transv

75
Q

CRT has been shown to reduce what ?

A

HF sx, hospit and death

76
Q

what does CRT do .. ?

A

Paces RV and LV to resynchronize

77
Q

CRT indication - strong recommendation

A
  1. SR
  2. Sx ( NYHA II- III, ambulatory IV )
  3. on GDMT
  4. EF < 35%
  5. typical LBBB
  6. QRS > 130s
78
Q

HFpEF management driven by what ?

A
  • sx driven
  • rely on risk factor modification
79
Q

SGLT2i for HfpEF ?
- if so helps in what ?

A

yes all, even if not diabetic

80
Q

Candesartan helps in what for HFpEF ? per which trial.

A
  • decreases HF hospit per CHARM preserved trial ( not MACE)
81
Q

MRA decrease what in HFpEF in topcat trial ?

A

HF hospit

82
Q

Firearts HF trial HfPEF states what ?

A

Finerenone, a novel non steroid MRSA, decrease the composite of worsening HF events and CV death compared to placebo

83
Q

GLP-1 agonist , new role in hfpef? in gudeline ?

A
  • sx control
  • weight loss
  • CV death and hospit

not yet in guideline

84
Q

it is based on which trial to state that sglt2i can be used in hfpef patients ? ( 2 trials)

A

based on emperor preseved and deliver trials. no reduction in mortality. only reduction in HF hospit

85
Q

can you use MRA, ARB or ARNI ?

A

yes could be considered to reduce HF hospitalisation especially if EF on the lower end spectrum ( 40-50%)

86
Q

are tehre any benefit to use ARNI in hfpef patients ? based on what study ?

A

no benefit ( although maybe a subgroup with ef 45-49%) . based on the paragon hf group

87
Q

up to how low of egfr can you use sglt2i to reduce hhf ?

A

20

88
Q

when do you give iron in HF population

A

consider if ferritin <100 or if ferritin 100-299 + tsat <20%

89
Q

gdmt for patients on chronic dialysis ?

A

yes !

90
Q

canaglifolozin ok for egfr 20 ? if not which one

A

no. empa

91
Q

trials for canagliflozin in non diabetics ?

A

no

92
Q

what can you add to help wth alkalosis when giving diuretics ?

A

acetazolamide

93
Q
A

cardio RC (4 decks)

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