cardio journal Flashcards
How does idraparinux c/w warfarin in treatment of DVT & PE?
Idraparinux not inferior to warfarin in the DVT Study, but it was inferior in the PE Study.
How does dabigatran c/w warfarin for treatment of VTE, after initial parenteral anticoagulation?
Dabigatran is noninferior to warfarin in the prevention of recurrent VTE and PE events.
True or false? Rosuvastatin a/w significant reduction in risk of VTE?
True. In trial with “healthy” ppl, rosuvastatin a/w significant reduction in VTE risk.
Anti-Parkinsonian drugs (dopamine agonists, eg. pergolide / cabergoline) a/w with significant increased risk of what?
Heart-valve regurgitation. People on these meds should get regular TTE follow-up.
What is OMT for severe AS?
Trick question! No effective medical therapy for severe AS; need mechanical correction. Valve replacement definitive management.
What is better in someone with atherosclerotic renovascular disease: OMT, or OMT+endovascular revascularisation?
OMT alone. Revascularization carried substantial risk, and not a/w any benefit in terms of renal function, blood pressure, renal or cardiovascular events, or mortality.
Renal failure patients at risk of CVD events. Does a regular statin (rosuvastatin) decrease CVD events?
No. AURORA trial found rosuvastatin significantly reduced LDL-C and CRP, but was not a/w reduction in MI, stroke, or death from CVD causes.
True or false? Relatively small reduction in LDL-C level sustained over a lifetime markedly reduces incidence of CHD.
True.
Is it worth prescribing statins to men with hypercholesterolemia, who have no PHx of MI?
Yes. Statin treatment for ~5yrs provided an ongoing reduction in the risk of major CVD events for an additional period of up to 10 yrs. Presumably due to stabilisation of existing plaque and a slowing of the progression of CAD.
What antiHTN should be used in patients >80 years?
HYVET (Hypertension in the Very Elderly trial ie >80 years old) showed that indapamide +/- perindopril significantly reduced risk of death from stroke AND death from any other cause in very elderly patients, and reduced heart failure, with target BP
Which patient groups should get diuretics for treatment of pre/HTN?
First-line for HTN with no other comorbidities: thiazide diuretic - effective AND low cost
Which patient groups should get CCB for treatment of pre/HTN?
Elderly at risk of stroke
Which patient groups should get BB for treatment of pre/HTN?
Appropriate first line therapy if patient does not have pre-existing conditions
Which patient groups should get ACEI/ARB for treatment of pre/HTN?
T2DM and/or renal disease
Is medical therapy indicated in people with preHTN and 1+ CVD RF?
Yes. Choose one of: diuretics, BB, ACEI, ARB, CCB.
What lifestyle changes can help treat mildly elevated BP (pre-HTN) (when pt has no other CVD RFs)?
Weight loss, decrease dietary sodium, stop smoking, exercise.
What is more important in terms of RF for CVD and renal disease: elevated SBP or DBP?
SBP
What is the BP target for normal ppl? For ppl with DM or renal failure?
Normal:
How can you differentiate clinically b/w diastolic and systolic HF?
You can’t reliably distinguish between these patients.
What proportion of HF patients have diastolic HF?
1/3rd
What is the definition of diastolic HF?
HF with EF > 50%
Which patients do better? Diastolic or systolic HF?
Similar in-hospital complication rates, 1-yr mortality & morbidity.
According to the AHA Science Advisory (2005), who is the optimal candidate for CRT?
Dilated cardiomyopathy (non/ischemic), LVEF 120ms, SR, NYHA class III or IV despite OMT.
Is CRT worthwhile in those with HF class III, EF
There was significant improvement in NYHA class, but no significant improvement in terms of QOL, 6-minute walk test, LV reverse remodelling; ie) not recommended
Is it worthwhile replacing iron in symptomatic, iron deficient, HF patients? Does it matter if they are anaemic or not?
Good to replace iron in iron deficiency: improves symptoms, physical performance, QOL. Benefit in those with and without anaemia.
Is newer LVAD (continuous-flow) superior to older LVAD (pulsatile-flow)?
Yes. Newer LVAD had less device-related problems less hospitalisations improved QOL.
Is CRT+ICD useful in mild HF (class I or II) with reduced EF and wide QRS?
Yes. A/w 34% reduction in risk of death or HF events, and TTE showed improved LVEF after 1yr.
What is superior therapy in symptomatic AF with EF
Pulmonary vein isolation was superior; significant improvements in EF, 6-min walk test.
Which ACEI has been found to have a favourable effect on glucose metabolism in people with DM? (ie. Effects regression to normal glucose levels?)
Ramipril.
What is the best approach to preventing CVD morbidity/mortality in T2DM?
Appropriate management of hypertension, dyslipidemia, and other CVD risk factors
Does intensive glucose control in T2DM decrease microvascular complications (severe renal changes, decreased GFR, laser treatment, cataract extraction, vitrectomy, and new neuropathy)?
No (tested over a 5-6 year period)
Does intensive glucose control in T2DM decrease rate of CVD events?
No
Do the newer, atypical antipsychotics have a better arrhythmia profile c/w older typical antipscyhotics?
Current users of typical antipsychotic drugs and of atypical antipsychotic drugs in the study cohort had a similar dose-related increased risk of sudden cardiac death.
In patients in ICU post-resusc for cardiac arrest, which of the following is a/w increased in-hospital mortality? Arterial hypoxia, normoxia, or hyperoxia?
Arterial hyperoxia
True or false? Air pollution can impact cardiovascular health.
True
In APO, is NIV better, the same, or worse, than standard O2 therapy?
NIV is better. Safely provides earlier improvement and resolution of SOB, respiratory distress, and metabolic abnormalities. These do NOT improve rates of survival
What does apixaban target?
Apixaban is an oral factor Xa inhibitor
What was the outcome when apixaban given to patients post-ACS already on aspirin+/- clopidegrol?
Caused significant increase in bleeding events (including fatal and intracranial bleeding), without significant reduction in recurrent ischemic events.
Is there a role for widespread coronary artery calcification screening in asymptomatic adults?
Not recommended: no data shows that screening ultimately results in improved outcomes and reduced coronary events
Name two biomarkers useful for predicting death
BNP, CRP, Homocysteine, Renin, Urinary ACR. Biomarkers only added moderately to overall prediction of risk, c/w conventional CVD RFs.
Name two biomarkers useful for predicting major CVD events
BNP, Urinary ACR. Note: biomarkers only added moderately to overall prediction of risk, c/w conventional CVD RFs.
By what % does aspirin, used as primary prevention, reduce risk of MI?
Aspirin used as primary prevention reduces risk of MI by 30%
How does DAT (clop+aspirin) c/w aspirin alone, in terms of reducing risk of CVD events amongst people with stable CVD or people with multiple CVD RFs?
DAT was not significantly better than aspirin alone at reducing rate of MI, stroke, or death from CVD in this population of patients AND increased risk of mod-severe bleeding.
What is the difference b/w ticagrelor c/w clopidegrol in patients with N/STEMI?
Significantly reduced death from CVD causes, without an increase in the rate of overall major bleeding but with an increase in the rate of non-procedure-related bleeding.
Is there any benefit in prasugrel v clopidegrol in patients with ACS?
No siginficant benefit seen of prasugrel over clopidegrol in patients with ACS
How does fondaparinux c/w enoxaparin 9 days post-ACS?
Similar efficacy
How does fondaparinux c/w enoxaparin 30 days post-ACS?
Fondaparinux has substantially lower bleeding risk c/w enoxaparin lower long-term mortality and morbidity.
For the 48-hours post fibrinolysis for STEMI, how does unfractionated heparin infusion c/w enoxaparin?
Enoxaparin superior to infusing unfractionated heparin
Who does better? STEMI patients t/f post-fibrinolysis for early PCI, or those who are t/f only if fibrinolysis fails?
Early-PCI did much better c/w salvage PCI for failed fibrinolysis, in terms of death, re-MI, recurrent ischemia, CHF, cardiogenic shock, at 30 days post STEMI.
Is it worthwhile doing PCI on persistently occluded infarct-related artery 3-28 days post MI?
No. C/w medical therapy, PCI was more expensive, and initial benefits (in first few months post-PCI) in physical function not sustained at 1 year.
CABG or PCI for patients with three-vessel and/or L) main coronary artery disease?
CABG. Lower rate of major CVD events at 1 year. Standard of care.
Is there a difference in long-term survival or risk of MI for BMS v DES?
No difference. DES especially good at reducing clinical restenosis in patients with lesions at high risk for restenosis (high risk=2-3 of DM, small vessel diameter, long lesion).