Cardiology indications CC Flashcards
1
Q
STEMI: Fibrinolysis is generally preferred if
A
- Early presentation (3 hours from symptom onset and delay to invasive strategy)
- Invasive strategy is not an option
- Catheterization lab occupied/not available
- Vascular access difficulties
- Lack of access to a skilled PCI lab
- Delay to invasive strategy
- Prolonged transport: (door-to-balloon) - (door-to-needle) is >1 hour
- Medical contact-to-balloon or door-to balloon is >90 minutes
2
Q
STEMI: An invasive strategy is generally preferred if
A
- Skilled PCI lab available with surgical backup
- Medical contact-to-balloon or-door-to balloon is < 90 minutes
- (Door-to-balloon) - (door-to-needle) is < 1 hour
- High risk from STEMI
- Cardiogenic shock
- Killip class is ≥ 3
- Contraindications to fibrinolysis including increased risk of bleeding and ICH
- Late presentation
- Symptom onset was >3 hours ago
- Diagnosis of STEMI is in doubt
3
Q
Absolute contraindications to thrombolysis
A
- Any prior ICH
- Intracranial neoplasm, aneurysm, AVM
- Ischemic stroke or closed head trauma w/in 3 mo
- Head/spinal surgery w/in 2 mo
- Active internal bleeding or known bleeding diathesis
- Suspected aortic dissection
- Severe uncontrollable HTN
- For SK, SK Rx w/in 6 mo
4
Q
Relative contraindications to thrombolysis
A
- History of severe HTN, SBP >180 or DBP >110 on presentation (? absolute if low-risk MI)
- Ischemic stroke >3 mo prior
- CPR >10 min
- Trauma/major surgery w/in 3 wk
- Internal bleed w/in 2-4 wk
- Active PUD
- Noncompressible vascular punctures
- Pregnancy
- Current use of anticoagulants
- For SK, prior SK exposure
5
Q
Percutaneous VADs
A
- Short-term (<14 days) therapy of cardiogenic shock
- Bridge to procedure (e.g. longer-term VAD placement)
- Cardiac support for complex percutaneous cardiac procedures
6
Q
Beta blockers contraindications
A
- HR <60
- SBP < 100
- CHF
- High-grade heart block
- Severe bronchospasm
7
Q
Pericardiocentesis
A
- Treatment for clinically significant pericardial tamponade
- Occasionally diagnostic
8
Q
Contraindications to Pericardiocentesis
A
- Uncorrected bleeding diatheses in nonemergent setting
9
Q
TEE contraindications
A
- Perforated viscus
- Esophageal stricture
- Esophageal tumor
- Esophageal perforation, laceration
- Esophageal diverticulum
- Active upper GI bleed
10
Q
Urgent Invasive Therapy Indications for UA/NSTEMI
A
- Heart failure or hemodynamic instability
- Refractory angina that is not responding to maximal medical therapy
- Life-threatening arrhythmias, including sustained ventricular tachycardia
11
Q
Indications for Early Invasive Therapy (within 24-48 hours) for NSTE-ACS
A
- Elevated cardiac troponins
- Dynamic ST-segment changes
- Glomerular Filtration Rate (GFR) < 60 mL/min
- Left ventricular ejection fraction (LVEF) < 0.40
- Angina that is recurring but not severe enough to demand immediate intervention
- Recent Percutaneous Coronary Intervention (PCI) within the previous six months
- History of myocardial infarction (MI) or Coronary Artery Bypass Grafting (CABG)
- Diabetes mellitus
- Intermediate or high-risk patients per clinical judgment or established risk scoring systems
12
Q
Indications for Intra-Aortic Balloon Pump (IABP)
A
- Cardiogenic shock not responsive to optimal medical management
- Mechanical complications of myocardial infarction (ventricular septal defect, papillary muscle rupture)
- Refractory ischemia or life-threatening arrhythmias
- High-risk percutaneous coronary interventions
- Bridge to surgery in patients with critical valvular disease
- Bridge to transplant or left ventricular assist device in patients with refractory heart failure
13
Q
Contraindications to Intraaortic Balloon Pump (IABP)
A
- Severe aortic regurgitation
- Aortic dissection
- Significant peripheral artery disease, including iliac artery stents and iliofemoral grafts/stents
- Active sepsis
- Active bleeding or bleeding disorders
14
Q
Indications for Temporary Pacemaker
A
- Symptomatic bradycardia unresponsive to atropine
- Hemodynamic instability from bradyarrhythmias
- Acute anterior MI with Mobitz Type II second-degree AV block, complete AV block, or new bifascicular block
- Overdrive pacing for drug-resistant tachyarrhythmias
- Special situations: general anesthesia, cardiac surgery, electrophysiological studies, or specific drug overdoses
- Inferior MI with complete AV block may not need a pacemaker if the patient is stable, heart rate is >40-50 bpm, and QRS complexes are narrow
15
Q
Indications for Ventricular Assist Device (VAD) Placement
A
- Cardiogenic shock refractory to medical therapy including inotropes
- Persistent end-organ dysfunction due to low cardiac output
- Life-threatening arrhythmias related to heart failure
- Bridge to transplant for patients on the heart transplant list
- Destination therapy for patients who are not candidates for heart transplantation
