Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Cath Sap 5 board prep > case selection > Flashcards

case selection Flashcards

1
Q

for cabg questions will you need to calc a complex score for the boards (ie TIMI, Syntax)

A

No

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Dr Whites Key point re PCI and CABG?

A

suspend reality. Need to do what evidence suggests not what you would do.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Things that favor CABG

A

good targets, high complexity, med-high syntax score, insulin dependent DM, poor dapt compliance, coexisting valve dz, less comorbidiy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is class I indication for revasc of SIHD? What is class IIa?

A

stenosis > 50% with limiting angina > 50% unresponsive to OMT. Stenosis > 50% with dypnes or CHF and > 10% LV ischemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

In SIHD what percentage of LV ischemia is signficant?

A

>10%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is considered prognostically signficant disease if stable angina or silent ischemia

A
  1. Left main > 50% 2. Any LAD > 50% with documented ischemia or FFR <0.8 3. 2VD or 3 VD with LV dysfunction with ischemia or FFR < 0.80 4. Large area of ischemia > 10% 5. Remaining patent vessel > 50% with ischemia or + FFR
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is class III for revasc?

A

1VD, no LAD > 50%, no ischemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

When CABG based on the guidleines by bonow?

A

1VD pLAD, 2VD with PLAD 3VD syntax <22 CABG is I and PCI is IIa 3VD syntax > =22and Syntax > =22 then CABG class I and PCI class III LM isolated CABG class I (PCI IIa) LM + 2VD or 3VD Syntax < 32 CABG class I and PCI IIb, if syntax >=33 then pci falls to class III

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Only time PCI gets a higher class rec then CABG

A

1VD or 2VD non prox LAD (CABG IIb and PCI I

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

3VD syntax score that matters LM syntax care

A

>=22 however PCI in 3vd is IIb so PCI is pretty much not going to be a choice you want to take <33 or >=33 (although again if additonal lesions you are going to want to choose cabg (only real time you are good is isolated LM dz)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

PCI ____ symptoms but doesnt improve ____ in SIHD

A

reduces, surivival

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

PCI may ____ short term risk of MI, and does note ____ the long term risk of MI in SIHD

A

increase, lower

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Medical therapy on the exam

A

you will have to acknowledge that medical therapy will be a key component of this.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

what is higher in cabg than pci (2)

A

stroke and HD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

what drives MACE post PCI compared to CABG

A

TVR, and MI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What 2 trials show the CABG is better than PCI in pts with insulin treated DM with CABG

A

Freedom (18.7% vs. 26.6% 5 years)and Syntax (5 year MACE PCI 46.5 and CABG 29.0%),

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Culprit Shock showed what

A

higher frequency of mort and RRT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

SAFARI STEMI trial

A

fem vs. Radial

No difference in 30 d mor, no difference in bleeding

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

STEMI going to cath lab what do gl say to do before

A

asa 162 to 325 asa

P2?Y12 - Plavix 600, PRasugrel 60, Ticag 180

Heparin or bival

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Algorhytm for presenting to non pci capable

A

will the transfer to device time be less than 120 min then tx

if > then lyse

Need a regional system of stemi care rec I

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

When dont watn to lyse even if expected door to tx time >120 min (%)

A

Cardiogenic shoc

high ris features:CHF

? ant mi

Later presetnters > 4 hrs

CI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q
  1. what is goal to give fibrinolytic if decide to do so]
  2. post fibrinolysis tx?
A

30 min

always need tx for an angio

  • no reperfusion or reocclusion urgent
  • transfer for angio & revasc 3-24 hours
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

GL recs for rescue PCI

A

class I, 3x mort if didnt do this.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What antiplts to support pci after fibrinolyisis/

A

< 24 hours 300 mg and > 24 hours 600 , can also give prasugrel 60 mg if > 24 hours and fibrin specific and 48 hours if fibrin nonspe adgent

25
Q

Can you give prasugrel after TPA per the guidelines

A

YEs if PCI is 24 hours after with fibrin spe adgent or 48 hours after with non fibrin specific agent

26
Q

300 or 600 mg post lysis with pci

A

300 mg if PCI within 24 hours and 600 mg if PCI after 24 hours (note see prior card on age for adjuncitve inital antiplts 75 give 75 and if younger give 300 mg). This shit is so fucking dumb

27
Q

can you do CABG for STEMI

A

GL say class I for stemi and not amenable to PCI

also class I for repeair fo mechanical defects

28
Q

Hypotheremia protocol recs

A

Out of hospital arrest and shocable rhythm

In hospital arrest and nonshockable

targeted temp between 32-36

goal is 24 hours

class III for prehosp cooling with rapid infusions of cold saline

29
Q

ACC/AHA guideline update for people with CAD 5 things needs

A

antiplt with asa 81 and plavix, ticag, prasgurel 1 year post ACS

lipid lowering therapy to decrease LDL by 50% or to < 70 for very high risk

Anti HTN for bp goal < 130/80

ACE inhibitor (if htn or LV dysfunction)

BB preferably coreg

30
Q

Metabolic syndrome

5 compontents

A

Hallmark is abd obesity

Men

Wait > 40 and Women > 35

TAG >=150 men and women

HDL-C men < 40 women < 50

BP >= 130/85 for men and women

FBG >=100

31
Q

if have DM with metabolic syndrome risk?

A

doubles

32
Q

what did the diabetes prevention program show

A

showed meformin decreased progression to DM by 31% and lifestyle cahnges by 58% (no metformin)

33
Q

Hople trial showed what

A

ramipril had a reduction in DM (25-30%) reduction

Dr. LAvie prefers ARBs due to recent increased risk of CAncer

34
Q

HTN GL change why did they change

A

Sprint trial (goal was to get it to <120/80 got it to 121/80)

intesive bp mangement had a 23% reduction so GL recd 130/85 goal

35
Q

**2017 GL on antihtn

4 stages and treatments

A

4 cat

nomral <120 or < 80

elevated 120-129/80

HTN

stage 1 130-139/80-89

stage 2 >= 140 or >=90

36
Q

ASCVD risk calc overestimates and underestimates in what groups

A

over hisp and asians

under in American indians

37
Q

So how do we use the categories of bp now with the ASVD calc

A

BP stage I 130-139/80-90, and risk calculator 10 year risk >=10% ortherise start 140 over 90

38
Q

6 livestyle interventions to reduce bp

A
  1. reduce salt
  2. DASH diet
  3. Exerices
  4. Avoid high etoh
  5. increase potassium
  6. reduce and maintain weight
39
Q

<130/80 goal 2x need to start meds (what comorbid) 2 exceptins where can go with 140/90 goal

A

130/80 trheshold

  1. DM
  2. Ckd and CKD with renal txplt
  3. CHF
  4. Stable ischemic heart dz
  5. stroke prevention (lacunar onlu
  6. PAD

140/90 threshold ASCVD risk score <10% and do not have one of the above comorbiditis.

and hx of CVA (non lacunar

40
Q

What is counted as ASCVD

A

ASCVD

angina

stroke/TIA

revasc for CAD

(in new ris score atheroon cath doesnt count as ascvd, 50% lesion for example but I would also a ca score of a 1000%

41
Q

Secondary prevention guideline algo

A
42
Q

high does statin

A

crestor 20/40

lipitor 40/80

43
Q

What is very high risk ASCVD (4)

What does this do?

A

Need 2 of these or 1+ High risk condition

recent ACS <12 mo

Hx of MI in addition to current event

history of ischemic strok

Symptomatic pad

High risk conditions: (everyeone)

age >65, hetero hyperchol, CABG or CAD outside of current events

HTN, DM, CKD GFR < 60, smoing, LDL >=100

CHF

Need LDL < 70 mg /dl

44
Q

Who needs LDL <=70 secondary prevention

A

High risk ASCVD

-note I feel this should be < 50

45
Q

<20 yo primaryprevention need statin

A

only for FH or LDL >190 need high intesity statin

46
Q

Primary prevention for statin 40-75nyears old

A

ASCVD >7.5 or between 5-7.5 +risk enhanancers

47
Q

reimary prevention for statin use algothrym

A
48
Q

when do you do CAC

A

40-55 with 10 year risk 5-7.5 with ris enhanceing factors to better understand risk

Men 55-80 and women 60-80 with low burgen of risk factors who wonder if would benefit

49
Q

Zetia reduciton in LDL

PCSK9% lowering

A

15-20%

60% lower even on statin –> can reduce plaque (evoluquiamb) on us

50
Q

aliroucamab amazing hting

A

mortality reduction

51
Q

High TAG and low HLD?

A

Reduce it - EPA in reduce it 25% reduction and 20% reduciton

52
Q

asa primry prvention

A

low dose asa 81 only high risk patients for ASCVD age 40-70

No routine use of asa ofr those <40 or >70 and leave to clnincaian

53
Q

What is the CAC score lavine consideres high ris

A

top 25% for age

or > 200ish

54
Q

In gereral ACS/UA need these meds

A

BB

ACE

Statin

ASA + Statin

55
Q

What does lavine consider a high tAG

A

200

56
Q

PCSk9 Eving house trial

A

2 years evolucamab <25, those with

57
Q

Firstine rx of HTN these 3 medications

A

HCTZ/ACE,ARB or CCB

58
Q
A
59
Q
A

Cath Sap 5 board prep (12 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions