Cardiology – NSTEMI

Question 1

Initial aspirin dose at the time of presentation for ischemic chest pain?

Clopidogrel dose?

Answer 1

325 then 81 daily

600 loading then 75 daily

Question 2

Patient on Clopidogrel requires CABG. management to avoid preoperative bleeding?

Answer 2

Stop Clopidogrel 5 to 7 days before surgery

Question 3

prasugrel/ticagrelor vs Clopidogrel?

Answer 3

#More potent 
# faster onset of action
#Does not require hepatic metabolism

Question 4

When to use unfractionated heparin versus low molecular weight heparin or fondaparinux?

Advantages of LMWH and fondaparinux?

Answer 4

Chronic kidney disease or early invasive approach

#Dose 1-2 times daily
#No requirement to monitor therapeutic levels

Question 5

Do not give nitrates to any patient who has also taken this within 24 hours?

Answer 5

PDE inhibitor

Question 6

Prasugrel is contraindicated in which patients?

Answer 6

#over 75 years
# under 60 kg
#History of stroke/TIA

Question 7

Ticagrelor has decreased effectiveness when paired with?

Answer 7

Aspirin dosage over 100

Question 8

Age to give high intensity versus moderate intensity statin?

Answer 8

High-intensity if under 75 years

Question 9

When to give CCBs or Ranolazine for CAD?

Answer 9

Relief of symptoms when maximal tolerated dose of beta blocker has been achieved

Question 10

Takotsubo cardiomyopathy?

ECHO may show?

Treatment? General course?

Answer 10

Often associated with stress (broken heart syndrome)

Mid and apical wall abnormalities with sparing of bagel segments

Supportive; 95% have resolution of symptoms within seven days

Question 11

In women with coronary artery disease, it is recommended that?

Answer 11

Medical therapy be initiated prior to consideration for revascularization (higher complication rate with revascularization)

Question 12

PCI in diabetics – this is recommended?

Answer 12

Drug eluting-stent to reduce restenosis

Question 13

When to stress test a diabetic?

Answer 13

#Symptomatic
#Initiating an exercise program
#Known CAD and 3+ years without stress test

Question 14

Medical therapy for all patients with NSTEMI?

If patients are high risk? (High risk meaning?)

Answer 14

#Aspirin
 #Nitrate
 #Beta Blockers
#Statin
 #P2Y Inhibitor 

Add glycoprotein 2B/3A inhibitor 
#TIMI over 2
#Ongoing angina after initiation of standard antiplatelet/anti-anginal medications reinfarction
#heart failure