Exam 4 (IHD & VHD) Flashcards
Which drug class prolongs the life in patients with a history of coronary artery disease?
A) Beta-blockers
B) Calcium-channel blockers
C) Nitrates
D) Statins
A) Beta-blockers
Which diagnostic data correlates with the presentation of unstable angina? (SELECT 2)
A) Negative troponins
B) 12 lead ECG without ST-segment elevation
C) Positive troponins
D) 12 lead ECG with ST-segment elevation
A) Negative troponins
B) 12 lead ECG without ST-segment elevation
The MOST significant predictor of stent thrombosis is the discontinuation of:
A) P2Y12 inhibitors.
B) statins.
C) beta-blockers.
D) aspirin.
A) P2Y12 inhibitors.
A patient presents to pre-op with a history of active chest pain, hypertension, and diabetes mellitus type 2 for the removal of a left-hand cyst. The BEST plan the RRNA can anticipate is:
A) administering a nitroglycerin gtt IV.
B) the surgery being canceled.
C) performing a regional block.
D) consulting an endocrinologist.
B) the surgery being canceled.
A benefit of aortic valve replacement in patients with aortic stenosis is:
A) increased ventricular hypertrophy.
B) increased ejection fraction.
C) decreased cardiac output.
D) decreased stroke volume.
B) increased ejection fraction.
In mitral stenosis, decreased stroke volume is related to:
A) bradycardia.
B) pulmonary hypotension.
C) decreased right atrial pressure.
D) atrial fibrillation.
D) atrial fibrillation.
An anesthetic goal for mitral regurgitation is:
A) increasing the regurgitant fraction.
B) increasing the heart rate.
C) reducing the stroke volume.
D) maintaining slightly higher blood pressure.
B) increasing the heart rate.
The pulmonic valve is auscultated at the:
A) 2nd ICS, LSB.
B) 2nd ICS, RSB.
C) 5th ICS, LSB.
D) 5th ICS, RSB.
A) 2nd ICS, LSB.
What occlusion constitutes stable angina?
70%
What dermatomes are affected with angina pain?
C8 to T4 (nipple line)
Chronic stable angina is defined as?
CP that does not change in frequency or severity in a 2month period.
Unstable angina is defined as?
CP increasing in frequency and/or severity without increase in cardiac biomarkers
What cardiac diagnostic test has greater sensitivity?
Nuclear stress imaging
Nuclear stress testing can estimate & differentiate what?
- Estimate LV systolic size & function
- Differentiate between new & old MI
What med lights up during nuclear stress imaging?
Thallium
What nuclear stress imaging meds dilate the coronaries?
- Adenosine (Brand names: Adenocard, and Adenoscan)
- dipyridamole (brand names: Attia, Ofcram, Persantin, Persantin Retard, Trolactin)
Relate PPI’s to P2Y12 inhibitors?
PPI’s decrease the function of P2Y12 inhibitors
What meds are contraindicated in severe aortic stenosis & hypertrophic cardiomyopathy
Nitrates
Why are statins used in IHD?
To stabilize plaque
Troponin levels start increasing within ___ after an MI and can be elevated for up to___?
- 3 hours
- 7 to 10 days
If tPA is indicated, when should it be started?
Within 2-3 hrs after onset of S/S
Unstable angina lasts ____?
> 10mins at rest
When is tPA therapy not recommended?
- When the vessel is not fully occluded
- Or when the occlusion broke thru the intima (But how would one know)?
What anesthetic interventions are contraindication with DAPT?
Neuraxial anesthesia
How long should one take DAPT after receiving a bare-metal stent?
What about a drug-eluting stent?
What about balloon angioplasty without stent?
- 6 weeks
- 1 year
- 2 weeks
What drug is preferred in IHD, atropine or glycopyrrolate (Robinul) & why?
Glycopyrrolate (Robinul) as it has less chances to cause arrhythmias
What all results in 1 point on the cardiac risk index?
- High risk Sx
- IHD
- CHF
- Stroke
- DM with insulin
- Creatinine >2
1 MET equals to ____ of energy consumption?
3.5 mL/kg/min
Emergent Sx has to be within ____ hours?
Urgent Sx has to be within ____ hours?
Time-sensitive Sx has to be within ___ weeks?
- 6 hours
- 6 - 24 hours
- 1 - 6 weeks
What induction drugs are preferred in someone with severe LV dysfunction?
Opioids only (if possible)
Direct laryngoscopy should be less or equal to ____?
15 seconds
