CARDIO-CVA

Question 1

What ABCD2 score entails ED admission?

Answer 1

ABCD >5

Total-0-7
AGE
BP 
CP of TIA
Duration: >60m
DM = 1

Question 2

What is role of PCPA ?

Answer 2

manage

1. HTN- priority if PMH of CVA
2. Lipids-ADD higher does prn
3. ADD Platelets- Primary rec based of EBM. Be thoughtful w/ med prescription. MED changes
4. Determine function- PT/OT- Both, or if permanent management OT, if returning to prev. PT.

Question 3

What MUST BE done FIRST before treating a TIA with clot busters? IN ER?

Answer 3

CT scan- determine ischemia vs. hemorrhages

Do this to r/o b4 giving fibrolytic such at TPA to DEC risk of worsening hemorrhagic stroke

Question 4

What is the MC stoke?

Answer 4

1. Ischemic occlusive
2. Hemorrhagic
   CV or PV DZ
   HTN
   Atherosclerosis
   Dyslipidemia

Question 5

What do statins do to improve lipid levels?

Answer 5

HMG CoA reductase inhibitors- only DEC LDL production, does not affect current or diet

Enzyme Rate limiting step in synthesis of cholesterol
Insulin activates this process
Glucagon inhibits this process

Question 6

When should statins be taken? What does liver do at night? Why is important not to eat so late?

Answer 6

Liver makes cholesterol at night

Important to take STATINS at night to dec synthesis of Chol

Question 7

If person has LDL of 160 w/ comorbid, what is there goal and what statin is ideal?

Answer 7

Atorvastatin 20mg- 43% reduction

Normal LDL <100
Goal is 40% dec of 160

Question 8

What are lingering effects of stroke?

Answer 8

hemiparesis,
aphasia/dysphasia,
difficulty with movement, mild or
worsening cognitive impairment

Question 9

Which statin is high intensity reduce risk of recurrent stroke?

Answer 9

Atorvastatin 80mg (55-60% reduction)

Question 10

What are first choice agents in statin?

Answer 10

atorvastatin (Lipitor)
Zocor
pravastatin Pravachol
rosuvastatin Crestor INC ADE, $$

Question 11

What BP management dec stroke risk by 1/3?

Answer 11

DEC by 10mmhg in SBP
Volume reduction= Thiaz, ACEI
Tone reduction= CCB

HOWEVER, most important is numbers vs. agent, bc age will affect BP
Utilize MAP to determine improvement

Question 12

What are clinical finding in BP the indicate intergrity of aorta?

Answer 12

pulse pressure= SBP-DBP
Normal= 40
INC PP mean loss of compliance of aorta
SBP INC, LOW DBP
1. Calcification
2. Aortic Sclerosis
3. Aortic Regurg- INC SV

Aorta is elastic=can keep BP down
Ventricle relax- inc BP if relaxes on bolus of blood

Question 13

IF pt has INC PP >40, then what are steps?

Answer 13

Don’t want to lower BP with meds b/c diastolic will go down
INC risk of syncopal episode

LOW SBP, will low DBP

Question 14

What PE findings on TIA?

Answer 14

Dorsalis pedis diminished PHM of PAD

S4 diminished

Question 15

What anticoagulant dose will dec. risk of clotting?

Answer 15

Secondary preventinon
300-1300 same platelet toxicity
DEC by 22%

MOA- inhibits COX1- prostaglandin lining of GI, platelet toxin. DEC platelets sticking together

ADE- GI ulcers bleed

Question 16

What is a possible vasodilator, inhibits platelet enzymes

without bleeding risk, reserved for ASA fails?

Answer 16

Aspirin + Extended Release Dipyridamole (ASA-ERDP)

Dose- ​BID dosing​ and ​less well tolerated​- HA, $$

Question 17

What Inhibits ADP-dependent platelet aggregation

trials ​showed​ ​improved stroke risk relative to ASA​-only​ in pts with ​PAD?

Answer 17

Clopidogrel​ ​(Plavix)

○ No​ significant risk reduction in pts with ​previous ischemic stroke​ (MATCH Trial)
○ Combination ​(Plavix + ASA)​ increases bleeding
○ DeRosa says he would probably switch this case pt to Plavix, though the evidence doesn’t necessarily
support it.

Question 18

What is not an recommended drug if PT has EKG NSR?

Answer 18

Warfarin -A-fib, valves is indicator only for this drug

Question 19

What surgery decreased risk from 26%-9% for Fatal ipsilateral stroke or postoperative death for those with severe symptomatic stenosis​? What is amount occlusion needed to be seen on US?

Answer 19

Carotid endarterectomy
■ Need to see minimum of 70-99% occlusion on ultrasound before recommended
■ Less occlusion w/ surgery INC stroke risk

Question 20

Can reduce LDL by 50% or more; have an ​additive effect​ with statins

Answer 20

PCSK9 inhib
Alrocumab
Evolocumab
INJ
resistant or familial forms

Question 21

Mr. Holley had a recent stroke, BP 150/99?What is considered in clinic?

Answer 21

When was stroke
Type of stroke
Time span btwn acute attack and office visit

Pt needs anithypertension meds-dec CV work, DEC 28% for recurrent stroke. Risk reduce of 10mmHg is great!

Lipid control- dec thick vessels
PT for L hemiparesis
ASA-dec clot risk, 300+

Question 22

What should NEVER be used in hemorragic stroke?

Answer 22

ASA!!!- thins blood clots travel quicker
INSTEAD
Clopidogrel 75mg
Asprin extended release dipryadmole 25mg BID

Question 23

Pt had TIA, and PMH of ischemia stroke with high lipid levels, what is management?

Answer 23

Benefits of statin even with normal lipids

TX High intensity statin

Question 24

What is MC of cardioembolic stoke?

Answer 24

Valves nonvalvular atrial fib
Rhythm dysfunction

LABs- ECHO w/ doppler 1st
EKG

TX- Antiplatlet
Anticoagulant
Surgery alations