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MKSAP > Cardiology - CAD and ACS > Flashcards

Cardiology - CAD and ACS Flashcards

1
Q

Goal HR on beta blocker?

Beta blocker contraindicated in patients with?

A

55-60

#Symptomatic bradycardia you
#High grade AV block
#Acute decompensated heart failure
#Severe reactive airway disease
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2
Q

Medical therapy for patients with STABLE angina?

If continued symptoms?

If continued symptoms?

If continued symptoms?

A

Left heart catheterization

#aspirin
#Beta Blocker
#Long acting Nitrate
#Statin
#sublingual nitroglycerin
#ACE inhibitor (?)
#increase beta blocker deuce
#Increase long-acting nitrate does
#Add calcium channel blocker
#Optimize current medications
#Consider ranolazine
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3
Q

Patient with medically refractory angina is not suitable for PCI or surgical revascularization – options for management?

A 
#External enhanced counterpulsation
#Spinal cord stimulation
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4
Q

Indications for moderate to high intensity statin?

A 
#LDL over 190
#Diabetes
#7.5% ASCVD 10 year risk
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5
Q

Patients at risk for CVD should get which vaccine?

A

Influenza

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6
Q

Calcium channel blockers that are better for CAD?

A 
Non-dihydropyridines (provides coronary vasodilation AND reductions in heart rate)
#Diltiazem 
#Verapamil
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7
Q

Calcium channel blocker are contraindicated in patients with?

A 
#Left ventricular systolic dysfunction
#Advanced AV block
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8
Q

Ranolazine - MoA? When to prescribe?

A

Selected inhibitor of late in word sodium channel in the myocardium

For patients who remain symptomatic after beta blockers, nitrates, and calcium channel blockers

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9
Q

SYNTAX score?

A

Anatomic scoring system based on the results of angiography (useful in predicting outcomes of revascularization strategies)

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10
Q

PCI versus optimal medical management in stable angina?

A

No mortality benefit but improvement in quality of life

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11
Q

CABG warranted in which patients?

A 
#Left main disease
#Multivessel disease involving proximal LAD
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12
Q

Duration of dual antiplatelet therapy in patients with stable angina after:

  1. No stent
  2. Bare metal stent
  3. Drug-eluting stent
  4. CABG
A
  1. No do therapy
  2. Aspirin and Plavix for one month
  3. Aspirin and Plavix for one year
  4. Not indicated
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13
Q

Duration of dual antiplatelet therapy in patients with unstable angina/NSTEMI or STEMI after:

  1. No stent
  2. Bare metal stent
  3. Drug-eluting stent
  4. CABG
A

Aspirin plus

  1. Plavix/ticagrelor for one year
  2. Plavix/ticagrelor/prasugrel for 1-12 months
  3. Plavix/ticagrelor/prasugrel for 1 year
  4. Plavix/ticagrelor for 1 year
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14
Q

When to give dual antiplatelet therapy?

A 
#following PCI 
#following ACS
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15
Q

Medical therapy for STEMI?

A 
#Aspirin
 #Statin
 #Nitrates
 #BetaBlocker
 #Heparin
 #P2Y inhibitor (clopidogrel, ticagrelor)
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15
Q

Contraindications to thrombolytic therapy during MI?

A 
#Any previous intracerebral hemorrhage
#Known cerebrovascular lesion (AV malformation)
#Stroke in prior three months
#Suspected Aortic dissection
#Active bleeding
#Significant closed Head/facial trauma and past three months
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16
Q

Thrombolytic options for MI treatment? (TIMI Flow grade 2/3?)

A

Streptokinase (55%)
Alteplase (75%)
Reteplase (83%)
Tenectoplase (83%)

The higher the flow grade 2/3, the more effective for thrombolytic

17
Q

Arrhythmia that is considered benign if within 24 hours of reperfusion?

A

Accelerated idioventricular rhythm

18
Q

Thrombolytic failure occurs how often? How to tell if thrombolytics fail?

A

30%

 #Failure to resolve chest pain
 #Failure to improve ST elevation by 50%
19
Q

Caution using nitrates and analgesics in these type of infarcts? (Why?)

A

Inferior or right ventricular infarction

Can result in reduced preload and significant hypotension

20
Q

In patient with STEMI, beta blockers recommended in all patients except those with?

A 
#Hypertension
 #Bradycardia
 #Advanced AV Block
 #Heart Failure
21
Q

Dosing of metoprolol in acute ACS?

A

Three 5 mg increments q5 minutes

22
Q

Contraindications to ACE therapy?

A 
#Systolic blood pressure under 90
#Advanced kidney dysfunction
#Hyperkalemia
23
Q

How long to IDEALLY continue dual antiplatelet therapy after STEMI?

Minimum duration of dual antiplatelet therapy?

A

One year

Four weeks if bare metal stent implanted

24
Q

Role of heparin in acute ACS?

Prefer unfractionated or low molecular weight heparin?

When using heparin for primary PCI, guidelines recommend concomitant administration of?

A

Reduced incidence of reocclusion

Unfractionated (can monitor degree of anticoagulation)

Glycoprotein 2b/3a inhibitor

25
Q

Instead of heparin + glycoprotein 2B/3A inhibitor, can consider using? Advantage?

A

Bivalirudin (Direct thrombin inhibitor)

Similar rate of ischemic events but fewer bleeding events

26
Q

Diabetic presents with ACS, gold glucose level?

A

Under 180

27
Q

After/During MI, patient develops hypotension, jugular venous distention, but has clear lung fields.

Cause? EKG finding? ECHO finding? PA catheter finding?

A

Right ventricular infarction

ST segment elevation in V3R and V4R;

dilated RV with reduced systolic function;

elevated RA and RV pressure with low wedge pressure

28
Q

After/During MI, patient develops systolic blood pressure under 90?

Cause? EKG finding? ECHO finding? PA catheter finding?

A

LV infarction

ST elevation in anterior leads

Severe LV dysfunction

CI under 2; wedge pressure over 18

29
Q

After/During MI, patient develops holosystolic murmur along left sternal border. Often also presents with this sound?

Cause? EKG finding? ECHO finding? PA catheter finding?

A

VSD; thrill

Nonspecific (50% associated with anterior wall MI)

#High velocity left-to-right systolic jet
#systolic turbulence RV side
#Large V waves in wedge pressure tracing
#Step up in oxygen saturation from right atrium to left ventricle
30
Q

After/During MI, patient develops Holosystolic murmur at the left sternal border. Crackles on pulmonary exam. May also present with this auscultation finding?

Cause? EKG finding? ECHO finding? PA catheter finding?

A

Papillary muscle rupture (radiation of murmur to axillae)

Usually inferior/inferior-posterior wall MI

#Flail mitral valve leaflet with attached mass (papillary muscle head)
#Severe MR

Prominent large V waves in wedge pressure tracing

31
Q

After/During MI, patient develops hypotension, jugular venous distention, and distant heart sounds.

Cause? EKG finding? ECHO finding? PA catheter finding?

A

Left ventricular free wall rupture

Potentially pulseless electrical activity

#Pericardial fusion with Tamponade
#Discrete wall motion abnormality
#Defect in myocardium
#Equalization of diastolic pressures
#CI under 2
32
Q

Sinus bradycardia typically occurs after which type of myocardial infarction?

May also see these type of arrhythmias?

A

Inferior wall MI

#Atrial fibrillation
#Heart block
33
Q

Ventricular rhythm is arrhythmias suggest poorer mortality/mobility if?

A

After first 24 hours

34
Q

Patient develops persistent high degree atrioventricular block or symptomatic bradycardia after MI - next step?

A

Temporary transcutaneous or transvenous pacemaker

35
Q

RV infarction triad?

A 
#Hypotension
 #Elevated JVP
 #Clear lung exam
36
Q

RV infarction treatment?

A

inotropes (dopamine or Dobutamine) until RV function improves (usually 2-3 days)

37
Q

VSD after MI – management?

A 
#Vasopressor agents
#Intra-aortic balloon pump

Must get SURGERY (or if not, percutaneous VSD closure device)

38
Q

Etiologies of mitral regurgitation after STEMI?

A 
#LE dysfunction with annulus that location
#Worsening of pre-existing mitral vegetation
#Rupture of papillary muscle/chordae tendinae
39
Q

Treatment of mitral regurgitation after STEMI?

A 
#Vasodilators to reduce afterload
#Diuretics to decrease preload
#If unstable, intra-aortic balloon pump
40
Q

Risk factors for LV rupture?

A 
#Female
#Anterior Myocardial Infarction
#Incomplete Reperfusion
41
Q

LV thrombus is common (how common?) after which type of MI?

Treatment?

A

10-20% after anterior wall MI

Warfarin for 3-6 months

MKSAP (14 decks)

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