Cards 3

Question 1

According to Framingham, in order, what are the risk factors

Answer 1

Hypercholesterolaemia
Smokingcurrent
Psychosocial stressors
DM
Hypertension
Abdominal obesity 

If stop smoking, risk does return to baseline after 2-5 years

Question 2

Cut offs for premature coronary disease

Answer 2

male 45

female 55

Question 3

Young person with heart block and no risk factors think…

Answer 3

sarcoid

Question 4

Treat cardiac sarcoid

Answer 4

Steroids might halt progression

ICD to prevent SCD

Question 5

Most sensitive and most specific tests for cardiac sarcoid

Answer 5

PET most sensitive

CMR most specific

Question 6

Cardiac failure and periorbital purpura… think

Answer 6

AL amyloidosis

Dont really get raccoon eyes and macroglossia in other types
Also look for hepatomegaly disproportionate to the degree of heart failure

Amyloid heart- at risk of strokes because of AV dissociation even in the absence of AF

Cardiac faillure… diuretics but nor ACE, beta or calcium ch use

Question 7

LV thickening in amyloid,,,, what happens to the ECG voltage?

Answer 7

Reduces

unlike LHV from ischaemia

Question 8

What does CMR show in amyloid?

Answer 8

diffuse subendocardial heterogeneous pattern of increased signal on delayed contrast enhanced inversion recovery T1-weighted images

Question 9

What does CMR show in sarcoid?

Answer 9

delayed enhancement, which may be either mid-wall or transmural

nodular mid-wall hyperintense foci on black blood T2-weighted imaging

areas of focal myocardial thickening

Question 10

What is the process for in stent thrombosis vs re stenosis

Answer 10

Re stenosis gradual narrowing that presents usually as angina pain over 3-12 months post stent

Due to neointimal hyperplasia

In stent thrombosis is abrupt thrombus in previously good stent causing large MI or death. BAD prognosis - doesnt matter where in vascular tree. Usually in first 4 weeks

Due to non endothelialisation of stent

Question 11

Late stent thrombosis- where is the risk

Answer 11

Late stent thrombosis means in stent thrombosis after the first month
More common with DES because of delayed endothelialisation with DES

Question 12

Benefit of DES?

Answer 12

REstenosis rate reduced

Question 13

How is Clopidogrel metabolised?

Answer 13

CYP2C19

Smoking ENHANCES the antiplatelet effect of clopidogrel

Question 14

5 surgeries you cannot do on DAPT

Answer 14

intracranial
spinal
plastic reconstructive
TURP 
Extraocular

Question 15

When, for PCI, would you choose Clopidogrel over Ticagrelor

Answer 15

prior haemorrhagic stroke
active bleeding
bleeding diathesis
thrombocytopaenia

Question 16

NSTEMI undergoing PCI, what is the preference with GPIIbIIIa?

Answer 16

Use bivalirudin in pref to heparin
If use bivalirudin, do not use a IIbIIIa inhibitor
If heparin used and clop/tic/pras–>use eptifibatide or abcix/eptifibatide after angio

Question 17

If know having fibrinolysis, what APT would you give in STEMI?

Answer 17

aspirin and clopidogrel (not tic/pras)

Question 18

If having STEMI and PCI, what APT to give?

Answer 18

aspirin and pras/ticag
but not pras/ticag if active bleeding
not pras if ever stroke

Only give GP2b3a agent if no DAPT given pre angio