Coronary Artery Disease

Question 1

Inheritance pattern of familial hyperlipidemia

Answer 1

FH is the most common autosomal dominant genetic disease. Patients with FH usually have a functional mutation of one of three genes: the low-density lipoprotein receptor gene (LDLR; sometimes called the apoB/E receptor); gain-of-function mutations of the proprotein convertase subtilisin kexin 9 gene (PCSK9), and the apolipoprotein B gene (principally APOB3500).

Question 2

Indication for fibrinolytics in ACS

Answer 2

• When treatment with PCI > 120 minutes
• Door to medication time should be 30 minutes

Question 3

Prasugrel Black Box Warning

Answer 3

Due not use if history of CVA/ TIA, weight < 60, active bleeding, significant hepatic or renal dysfunction

Question 4

DAPT after NSTEMI

Answer 4

12 months of DAPT

Question 5

Strongest predictor following STEMI

Answer 5

LVEF

Question 6

Fractional Flow Reserve cut off for PCI

Answer 6

<= 0.8 for intervention.
Requires maximal hyperemia induced with intracoronary or IV adenosine

Question 7

Coronary Flow Reserve

Answer 7

< 2.5 is abnormal
- Stimulus to augment coronary flow = adenosine/ regadenosine

Coronary flow reserve (CFR) is defined as the ratio between coronary blood flow at maximal hyperemia and at baseline condition. It expresses the capacity of the coronary circulation to respond to a physiological increase in oxygen demands with a corresponding increase in blood flow.

Question 8

Contraindicated anticoagulation with planned immediate PCI

Answer 8

Fondaparinux

Question 9

Coronary vasospasm diagnosis

Answer 9

●Nitrate-responsive angina
●Transient ischemic ECG changes in the absence of obvious causes for increased myocardial oxygen demand
●Angiographic evidence of coronary artery spasm

Occasionally, a spontaneous episode may occur during diagnostic angiography so that all three elements may be documented. Provocative testing is needed if the diagnosis cannot be made during a spontaneous episode. During provocation testing, the diagnosis of vasospastic angina is confirmed if the provocative stimulus with acetylcholine induced chest pain, transient ECG changes, and a >90 percent constrictor response.

Sometimes, the diagnosis is made on a clinical basis from the history and ECG without angiographic evidence of vasospasm.