case managment/ AUC etc

Question 1

what is the dose of IV epi for severe analylaxis

What is pre med dosages

do you need to treat for shellfish allerg

Answer 1

IV 1:10K over 5-15 min

prod 50 x 3 over 24 hours planned for emergent pred 50 IV x 1 or hydrocort 200 mg daily

dont need to

Question 2

what are the treaments for severe reactions.?

Answer 2

Laryengeal edema SQ 1:1000, benadyl, hydrochort 200 mg

Hypotension

• IVF
• 1:10K IVP

Question 3

IV enox dose for PCI if have been given a dose

Answer 3

0.3 mg/kg

Question 4

SOHD when can you revasc

a. for sx -
b. for px - LM, LAD , 2VD or 3VD, LV dysfunction with ischemia or FFR < 0.80 for any lad

Answer 4

a. Stenosis > 50% with limiting anging
- sten > 50% with dyspnea or CHF and > 10% LV ischemia
- no limiting sx on OMT
b. for px
- LM > 50%
- any LAD > 50% with documented ischemia or FFR < 0.80
- 2VD or 3VD , LV dysfuntion with ischemia or FFR < 0.80
- large are of ischemia,
- )dont do pci for 1 VD not lad and no ischemia doc

Question 5

SIHD important class three for PCI

Answer 5

no ischemia documented non LAD vessel with single vessel dz

Question 6

PCI vs. CABG Guidelines

Answer 6

Can do CABG for all lesional varietes except 1vd/ 2vd no prox lad. (when should do PCI.

Should not do pci Class III 3VD syntax > 22 and ful revasc not possible.

LM + 2VD or 3VD with syntax >= 33

Question 7

synatx need to now for AUC (2)

Answer 7

> 22 and 3vd/2vd and full revasc not possilbe

>= 33 and LM + 2v or 3vd

Question 8

How do the guidelines consider PCI

Answer 8

reduces incidence of angina, may increase risk of short term MI and doesnt lower the long term risk of MI

Question 9

5 year syntax

Answer 9

no differnce in mort but higher mace due to higher revasc.

-<=22 no difference also lm.

22-32 3V subgroup does diverge but LM doesnt

Question 10

dm pci vs cabg

Answer 10

maace higher with pci 46b vs 29 p 0.0002

freedom 1900 18.7 vs 26.6 exception of stroke

Question 11

Syntax 2 interesting finding

Answer 11

women did better with cabg than pci

Question 12

CABG for survival

Answer 12

LM >50%

3VD

CABG or PCI VT due to ischemia mediated VT

lima to pLAD (single vessel dz)

Question 13

Syntax II what factors lowered syntax for CABG

Answer 13

female, younger, LVEF reduced

Question 14

LM PCI two major studyies

Answer 14

Nobel included repeat pci at 5 years no mor difference, older stent types.

Excel (xience) –> awaiting 5 year

Syntax LM no difference TVR high PCI and stroke higher for cabg (same theme)

Question 15

general theme of all PCI vs. CABG studies

Answer 15

no diff in mort, higher macce driven by TLR, higher stroe with cabg

Question 16

What did stitches show?

Answer 16

improved survival at ten years post CABG compared to medical therapy alone. EF < 35% no need for viability

Question 17

Drachmans 7 px reason for revasc with PCI - first four aare antaomic

Answer 17

1. LM
2. pLAD
3. multivessel dz
4. LV dysfunction
5. large ischemic burden
6. ischemic VT/cardiac arrest
7. acs CV shoc

Question 18

Guidleine genral concepts: Revasc vs. med therapy for SIHD

Answer 18

for those with silent ischemia or mild sx only revasc if adverse events –> VT, EF drop, MI

Question 19

When need a cath after noninvasive testing 4

Answer 19

resting or exercise induced lv dysfucntion, stress echo +

duke treadmill score greater than negative 11

LV dilitation or lung uptae with perfusion imaging

CAC >400 agaston

Question 20

CAC score in which recommend revasc?

Answer 20

> 400 agaston units

Question 21

revasc is most beneficial with what degree of ischmia?

Answer 21

> 10% per GL (not really in AUC interesting), in one study really was 20% (death 7% vs. 2%)

Question 22

courage trial basic facts

when did it end?

Answer 22

2004

inclusion angina or + NST and CAD on cath

2287 (1149 PCI + OMT and 1138 OMT)

follow up median 4.6 years

Question 23

Biggest issue with courage

Answer 23

crossover of 32%

also pci was not ischemia driven

PCI success 93%

Question 24

BARI 2 D study

inclusion

results

Answer 24

inclusion - DM and 50% >= stnnosis without prior intervention 2x2 factial

did not compare PCI to cabg, CABG vs. OMT and PCI and OMT

reduction of advers events with CABG revasc.

revasc did reduce angina

Question 25

fame 1005 patients FFR

Answer 25

FFR guided approach reduction in MACE (driven by revasc)

Question 26

Fame II

Answer 26

FFR PCI + OMT vs. OMT in stable CAD

Question 27

fame II 5 year

Answer 27

reduced death or mi at 5 years

Question 28

NSTEMI early invasive how early

Answer 28

2 hours if ongoing angina, hemodynamic stability, ischemia at rest or VT

24 hours otherwise–> in general iia