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Cardiology > Ischemic Heart Disease > Flashcards

Ischemic Heart Disease Flashcards

0
Q

Unstable angina

A
  1. Rest
  2. New onset<2 mos
  3. Increasing angina by a class
    3 kinds
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1
Q

Types of angina

A
  1. Typical chest pain with exertion relieved at rest or ntg
  2. Atypical angina has only 2 of the 3
  3. Non cardiac chest pain
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2
Q

Anginal equivalents in diabetics, woman, and elderly

A

Dyspnea
Nausea
Fatigue
Faintness

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3
Q

Types of mi

A 
Type 1 plaque rupture
Type 2 increase ischemic burden
Type3 death no enzymes
Type 4 sp pci 
Type 4b stent thrombosis
Type 5 sp MI
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4
Q

> 75 years

A

MI usually NSTEMI not STEMI
More likely CHF
Increase mortality

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5
Q

Mi therapy

A 
No nitro if BP is low
No iv betablockers
Morphine OK
No  Norvasc 
Oxygen if o2 below 90
No IV acei
iV lopressor only if the pain is persistent
Oral acei if EF below 40
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6
Q

Worst prognosis

A 
St-t changes and the level of tropinin 
CHF 
PCI <6 mos
DM
RF
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7
Q

Volume of the contrast

A

3.7x creatinine clearance

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8
Q

Timacs study

A

High rusk patients benifit from early invasive therapy

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9
Q

Prasugrel

A

Only in MI
Only after angio max
Donot pre load in the ER

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10
Q

Dose

A

Use only 80 mg Asa with ticagrelor

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11
Q

Plavix dose

A

It could be given in the ER or at PCI both class1

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12
Q

Cure study

A

Asa and plavix better than asprin alone
Use plavix for 1 year
Oasis7 high dose of plavix 600 and 150 is more effective the 300 and 75 but more bleeding

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13
Q

Triton study

A

Increase risk of stroke and MI in cyp2c19 carriers than non carriers

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14
Q

Prasugrel

A

More effective, faster acting, and potent than pkavix.

Don’t use it before you cath and no abciximab in the ER

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15
Q

Triton 38

A 
Don't use in stroke patients
Older
Less body weight
Decreased events in effient groups 
Decrease stent thrombosis
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16
Q

Ticagrelor

A 
Reversible binds to p2y12
Short acting
Less stent thrombosis than pkavix
Can give ticagrelor even on pkavix
Side effects dyspnea asthma and heart block
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17
Q

Renal failure

A

Adjust angio max dose

You can give angio max in the ER 2b

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18
Q

Acuity study

A

More bleeding with UFH and 2b 3a than with angio max
Fondoperimaux can cause increase thrombosis after PCI and according to the guide lines don’t need to be stopped till CABG

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19
Q

Triple anti thrombotic

A

Afib
CHF
Mechanical valve

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20
Q

Post mi

A

Flu vaccine
Fish oil
Aldo blockage for low EF

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21
Q

Enzymes

A

Elevated tropinin for 10 days.

If myoglobin is negative no MI it has high negative predictive value

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22
Q

Thrombolysis and tx in 3-24 hours to pci facility

A

Horizon study higher TLR with drug eluding vs BMS

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23
Q

Thrombolysis

A

Thrombolysis
75 yo use 75 mg pkavix
No data on effient or brillinta

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24
Q

After Thrombolysis

A

PCI24 need 600 plavix

All 2b 3a are class 2a indication sp mi

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25
Q

Sp tnk Thrombolysis

A

Enoxeparim less tan 75 bolus more than 75 no bolus

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26
Q

So mi

A

Eplerinone is class 1 for CHF Ephesus study

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27
Q

So mi

A

IABP no survival benifit

It’s 2a indication

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28
Q

Sp

Mi

A

Ventricular rupture day 3-5
If they have Thrombolysis 24 hours
MR post medial pap

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29
Q

Class of indication for 2b3a in mi

A

No class 1 all class2

30
Q

Highest risk of mi

A

Black male 65-74

31
Q

High risk in USA

A 
Tropinin 
ST depression
Age>75
Hypotension
Ongoing chest pain pain at the time of the exam
Crescendo angina past 48 hours
32
Q

Duke score

A

Intermediate score risk 10% over 5 years

33
Q

No treadmill for

A 
LBBB and WPW
STT depression >1mm
Paced rhythm 
LVH
Dig
34
Q

Duke score

Exercise in min-5x max ST depression- 4x angina index 0 no cp 1 non limiting cp 2 limiting cp-

A

Low score more than +5 one year 1% 5 year 3%
Intermediate risk score 4to -10 one year risk 1-3% five year 9.5%
High risk greater than minus 11 one year 3% and give year 35%

35
Q

High risk

A

Inability to achieve 85% HR
Heart rate recovery less than 11 beats a min
VEA VT

36
Q

Sensitivity and specificity

A

Stress EKG sen 68% specific 77%
Stress echo sen 80% specific 86%
Nuclear sen 84% specific 77%

37
Q

Adenosine

A 
Binds to A2A causing increase cAMP and vaso dilatation
Myocardial ischemia is rare 
A1 AV block
A3A4 bronchospasm
Hypotension 5%
No caffeine 
Don't use
HR slow or carotid stenosis
38
Q

Persantine

A

Use caution in liver failure

39
Q

Stress test recommendation

A

Intermediate risk interpretable EKG standard exercise EKG

Intermediate risk un interpretable EKG do imaging

40
Q

No stress tet

A

For low risk

41
Q

CTA and MR

A

Low to intermediate risk
No CTA if there are no symptoms
Low risk less than 100 agaston units and less than 50% lesion
Intermediate risk 100-399 one stenosis of 70% or two 50-69%
High greater than 400 and multiple lesions

42
Q

Swedish trial
Normal LV and stable angina
Decrease mortality and MI

A

Asprin only
Not nitrates
Not betablockers
Definitely not ca blockers

43
Q

Betablockers

A

Sp MI all patients with normal LV and continue for 3 years
Decrease HR beta 1
Decrease after load beta 2
Decrease contractiliry beta 1 and 3
No data on metoprolol tartrate data only on metoprolol succinate

44
Q

Acei
Clear benifit in mi CHF and HTN
Less clear in motmot endive normal LV

A

Hope Europa Camelot cv benifit

Pace, transcend and navigator no benifit

45
Q

Medical therapy vs CABG 1972-79
VA study
European study
Cases

A

Only sub group benefited are
3 vessel
Left main
EF<50

46
Q

Acme study

A

PCI has superior angina relief compared to medical therapy
Small increase in emergency CABG
Restenosis 40%
PCI has no effect on mi or mortality

47
Q

PTCA vs CABG

RITA ERACI CABRI EAST GABI BARI

A

Overall rates or mortality same
CABG superior to pci in diabetics mortality
Benifit of CABG in Diabetics due to Lima
Fewer mi cases in CABG
Less frequent angina in CABG

48
Q

PTCA(balloon)vs bare metal stent

A

No deference in death mi or emergent CABG

Bare metal stents were helpful in angiographic restenosis and repeat pci

49
Q

BMS vs CABG

Erica 2 ARTS SoS

A

Repeat revascularization low but still higher than CABG
No mortality benifit between CABG and pci
Did not achieve complete revascularization with pci

50
Q

BMS vs medical therapy
Courage 95% male VA study
Class 4 angina medically stable
Excluded ongoing chest pain, low EF,recent pci

A 
Used asprin plavix 
Betablockers amlodipiine and nitrates
Lisinopril 
Simvastatin
Smoking cessation
Weight loss

OMT and PCI are superior to OMT alone

51
Q

Revascularization vs OMT in type 2DM

Bari 2D

A

Both are identical

Aggressive diabetic control showed no deference

52
Q

Bari 2 D

A

PCI reduces angina
PCI does not reduce mi or mortality
Type 2 DM and SIHD revascularization vs medical therapy no change in mortality

53
Q

CABG vs DES
Syntax
Low syntax scores high strokes with surgery

A

More repeat procedures with stent group
Higher the syntax score( 22 )more cerebrovascukar complications with pci
Higher MACCE with pci
Overall adverse event rates are higher with pci 27% vs 37%
Neither all cause mortality nor stroke are defferent in both groups
Syntax greater than 33 much higher stroke and all cause mortality with pci
But stroke

54
Q

Freedom study
DES and CABG
Diabetes
2-3 vessels no left main

A 
Higher death and stroke
Higher mi with DES 
Higher stroke with CABG 
Higher repeat revascularization with pci 
Low syntax scores both are same
55
Q

Stitch
EF <35
No left main medical vs CABG

A

CABG did not reduce mortality but lower incidence of combined end points with CABG
Myocardial viability was useless

56
Q

Exercise no more than 30 min

2 drinks a day

A 
1200-1500 cal for woman
1500-1800 for man
69% American are over weight
Bmi over 30
All cause mortality 23%
Dash <25% cal from fat
57
Q

Jnc7

A

No alpha blockers as they worsen CHF

58
Q

All HAT

A

Chlorthalidone amlodipine and lisinopril all same

59
Q

Older patients over 60

A

Start treating at BP 150

But be aggressive in DM blacks and RF

60
Q

Metabolic x

A 
Obesity >40 for men
High tig
Low LDL 
HTN 
Hyperglycemia 
35% people inUS
Doubles the risk
61
Q

Lipid studies

A

TNT high and low Lipitor high is better

62
Q

Woscoos

A

Low LDL

Decrease mi and CCA by 23%

63
Q

Lipitor is better than pravastatin

A

High risk LDL <70
Intermediate risk 2 risk factors
Start at 130 and get to 100
Low (0-1 risk factors) risk start at 190 and get to 160

64
Q

Statin therapy

A

Do base line LFTs no need for yearly tests
Zeros no survival data
Niacin no survival data

65
Q

Pre op high risk

A 
Cad
CHF
Cva
DM 
Rf 
Are all high risk
No routine pre po beta blockers poise study has increase mortality
66
Q

Pre op

A

Do not stop plavix for one year

HTN is not a risk factor in pre op

67
Q

You can stop Coumadin in mechanical valves

A

Only of it is aortic and no other issues .

Resume in I week no bridging

68
Q

After pci

A

Surgery 14 days after POBA
6 weeks after BMS
12 mos after DES

69
Q

Intermediate risk for pre op

A

1-5% mi and death

70
Q

Horizons study

A

Angio max

As effective as heparin and 2b 3a but safer less bleeding and less deaths

71
Q

Lipid therapy

A

2 risk factors initial LDL therapy at 160

72
Q

Stress test

A

Normsl test event rate less than 2% a year

High risk >20 per year

73
Q

Greater than 50% patients

A

Will not have classic triad and atypical symptoms

Cardiology (18 decks)

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