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IM > Ischemic Heart Disease > Flashcards

Ischemic Heart Disease Flashcards

1
Q

Drugs used for Pharmacologic Stress Test

A

Dobutamine
Adenosine
Dipyridamole

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2
Q

Target LDL level for patients with CAD

A

<100mg/dL

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3
Q

Target LDL level for patients with DM

A

<70mg/dL

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4
Q

First line drugs for Chronic Coronary Syndrome

A

Beta Blockers and/or CCB

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5
Q

Risk Factors for IHD

A

Male > 45, Female > 55, HTN, DM, Dyslipidemia, Obesity, Smoking, Physical Inactivity, Family History of Premature CAD

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6
Q

Anginal Equivalents

A

Dyspnea, Fatigue, Faintness especially in elderly, women, diabetic

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7
Q

Canadian CVS Society Functional Classification of Angina

A

I - no limitation
II - slight limitation
III - marked limitation
IV - Inability to carry on any physical activity without discomfort

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8
Q

Patient experiences angina after walking two blocks on the level or after climbing more than one flight of stairs in normal condition. What functional classification?

A

FUNCTIONAL CLASS III

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9
Q

Second Line Anti-Anginal Drugs

A 
Nitrates
Ivabradine
Nicorandil
Trimetazidine
Ranolazil
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10
Q

When to send a patient with coronary angiogram?

A
  1. Stress Test negative or nondiagnostic with persisting angina
  2. Patients whose career involves safety of other with questionable symptoms
  3. AS or HCM with angina
  4. For Cardiac operation + Age
  5. After MI
  6. High Risk
  7. Nonatherosclerotic cause of MI
  8. Maximal therapy not effective
  9. EF<40% IHD not ruled out
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11
Q

Blood flow reduced at

A

50% stenosis

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12
Q

Blood flow limited at

A

80% stenosis

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13
Q

Drugs for Event Prevention in IHD

A 
C. A. S. A.
Clopidogrel
Aspirin
Statins
ACEi/ARBs
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14
Q

Indications for CABG

A

Left Main Coronary Artert
3 vessel disease + LVEF<50% OR DM
2 vessel disease that includes Left Descending Coronary Artery

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15
Q

MI Classification

A 
1 Spontaneous
2 Secondary to Ischemia
3 Biomarkers unavailable
4a PCI related
4b Stent Thrombosis related
5 CABG related
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16
Q

ECG findings in STE-ACS

A

ST Elevation >=2mm on V1-V6 or >=1mm in limb leads

17
Q

ECG Findings in NSTE-ACS

A

ST Depression >=1mm in any leads or T Wave inversion of at least 5mm

18
Q

LAD supplies leads?

A

V1, V2, V3, V4

19
Q

LCX supplies leads?

A

V5-V6, Inferior II, III, AVF (10%), High Lateral I, AVL

20
Q

Biomarker best for detecting re infarction?

A

CKMB

21
Q

TROPONINS can be detected for up to how many days?

A

Elevated up to 7-10 days

22
Q

CKMB can be detected up to how many days?

A

1 - 2 days

23
Q

Management for STE-ACS

A

Urgent revascularization via Thrombolysis and PCI

24
Q

Management for NSTE-ACS

A

Primarily medical

25
Q

High risk factors that warrant invasive management for NSTE-ACS

A 
Refractory chest pain
Persistent ST Deviation
Ventricular Tachycardia
Hemodynamic Instability
Signs of Heart Failure
26
Q

In NSTE-ACS, chest pain is severe and has one of the following (3):

A 
crescendo pattern
recent onset (<2 weeks)
occurring at rest or minimal exertion, lasting >10mins.
27
Q

TIMI Scoring for NSTE-ACS

A 
K. A. C. A. S. E. S. (1 point each)
Known CAD
Aspirin use within 7 days
CAD Risk Factors >=3
Age >=65
Severe Angina in last 24 hours
Elevated biomarkers
ST Deviation >0.5mm

High Risk if >=3 points

28
Q

First cardiac marker to rise in ACS

A

Myoglobin

29
Q

KILLIP Scoring for STEMI

A

I - normal BP, no congestion
II - moderate HF, bibasal rales, normal BP
III - Severe HF, midbasal rales, S3&S4, normal BP
IV - shock with SBP < 90, peripheral vasoconstriction, cyanosis

30
Q

Temporal Stages of STEMI

A

Acute - <7 days
Healing - 7 to 28 days
Healed - >=29 days

31
Q

STEMI patient initially seen at PCI-capable hospital. FMC-DEVICE TIME?

A

<=90 mins.

32
Q

STEMI Patient initially seen at non-PCI capable hospital. FMC-DEVICE TIME?

A

<=120 mins.

33
Q

Clear Contraindications to Thrombolysis in STEMI

A

A B C H H

Aortic Dissection (Suspected)
Bleeding (Active Internal)
Cerebrovascular Hemorrhage at any time
Hypertension (>180 SBP >110 DBP)
non - Hemorrhagic stroke within last year
34
Q

Most common cause of out of hospital death from STEMI

A

Ventricular Fibrillation

35
Q

Most common cause of in hospital death from STEMI

A

Pump Failure

36
Q

Most common cause of death within 24 hours of admission

A

Re - M.I.

37
Q

If a patient with acute MI presents with new murmur, think of 2 potential conditions:

A

free septal wall rupture

acute mitral regurgitation

38
Q

Ventricular Fibrillation/ Pulseless VTach

What will you do?!

A

SCREAM

Shock - defibrillate (monophasic - 360j, biphasic - 200j)

CPR

Epinephrine - 1mg every 3-5 minutes

Amiodarone - 300mg IV bolus then 150mg

39
Q

68/M came in for sudden onset of substernal chest pain. ECG revealed inferior wall STEMI without Right Ventricle involvement. Which medications are contraindicated?

A

Inferior wall STEMI without RV involvement - Beta Blockers

Inferior wall STEMI with RV involvement - Beta Blockers and Nitrates

IM (9 decks)

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