Ischrmic Heart Disrase

Question 0

Low risk

Less than 1% annual death

Answer 0

Duke score 5
No ischemic symptoms on max ETT
No ischemia on EKG
No stress induced wall motion abnormalities 
Coronary stenosis less than 50%
Minimal perfusion defect <5%
Cac score less than 100

Question 1

Angina

Answer 1

Typical sscp provoked by activity relieved with nitro

Atypical angina meet 2 characteristics

Non cardiac. One or none

Question 2

Intermediate risk

1-3% mi death

Answer 2

EF 35-49%
Wallmotion abnormality  2 segment and 1 coronary area
Cac score 100-399
2 vessel on CTA 50-69%
One vessel >70%
St changes 1mm on stress test with sx
Stress ischemia in multiple segments
5-9.9% myocardium at risk

Question 3

High risk >3% annual risk

Answer 3

Cac >400
EF 35% or less
Stress induced LV dilatation 
Ischemia in 2 territories 
Inducible ischemia at low work load 
Multi vessel >70%
LM greater than 50%
Vt VF 
Std more than 2 mm
10% drop in EF 
More than 10% muscle at risk

Question 4

Stable ischemic heart disease

Answer 4

May use plavix is pt is largo to asprin

Question 5

Guide line directed therapy

Answer 5

Moderate to high dose statin may consider bile acid or niacin
HTN below 140/90 acei for CHF and DM
Diabetes appropriate glycemic control

Question 6

BP management

Answer 6

Life style weight loss
Drug therapy for greater than 140/90
Acei, bb, ca blockers, thiazides

Question 7

Diet

Answer 7

Less than 5 gm salt per day
Saturated fats less than 10%
30-45 gm fiber

Question 8

Weight loss

Answer 8

40 inces for men

35 inches for women

Question 9

Influenza vaccine

Answer 9

Class 1 indication

Question 10

Class 1 for chronic stable cad

Answer 10

Lipids bmp
Carotid us
Echo
EKG 
Cxr

Question 11

Asa plavix

Answer 11

75-162 for cad. Class 1
Plavix if you can’t take Asa
Class 2b Asa and plavix
Class 3 persantine

Question 12

Beta blockers class 1

Answer 12

Normal EF use for 3. Years

EF less than 40% for life

Question 13

Renin blockers p

Answer 13

Ace first choice

ARB second line

Question 14

Nitrates

Answer 14

Don’t use in HOCM or with Viagra

Question 15

Bb

Answer 15

Don’t use in dr compensated CHF

Question 16

Ranolazine

Answer 16

Liver failure

Long QT

Question 17

For angina

Answer 17

Start with BB

Question 18

Class 2 b

Answer 18

Eecp
Chelation
Tmr

Question 19

Fish oil

Answer 19

Class 1

Question 20

Pci

Answer 20

Syntax score less than 22 pci

Syntax more than 22 CABG

Question 21

Left main low risk

Answer 21

Low syntax may do pci

Question 22

Freedom trial

Answer 22

Death mi stroke
5 years
Pci 26.6%
CABG 18.6%

Question 23

Diabetes

Answer 23

CABG preferred

Class 2a Lima to lad

Question 24

Lad proximal Lima to lad 2a Pci. 2 b

Answer 24

One vessel with no lad Class 3 both CABG and pci

Question 25

LV dysfunction

Answer 25

CABG 2a 35-50 2b less than 35% with out LM disease Sudden death vt Pci and CABG class 1

Question 26

No routine echos

Answer 26

EKG 2b

Question 27

FFR class 1

Answer 27

When evidence of ischemia could not be found Even if the stress test is positive clas 1 Lesion with high FFR class 3

Question 28

Fame study

Answer 28

FFR guided therapy | Low death mi and repeat revascularization

Question 29

Assess lvef if symptoms are worse

Answer 29

Class 1

Question 30

Follow up

Answer 30

``` Asa indefinitely class 1 DAPT for BMS one month class 1 DAPT for DES 6-12 Mos class 1 DAPT for high risk more than a year 2 b DAPT Undeferrable surgery class 2b ```

Question 31

Woman cad

Answer 31

Cad no disease 2.5% death Minimal 6.8% Significant 13.6%

Question 32

Woman cad

Answer 32

Increase hospitalization Diffuse disease Endothelial dysfunction

Question 33

EKG stress test

Answer 33

Do every chance you get on the exam

Question 34

Cad equivalent

Answer 34

DM PVD Symptomatic carotid disease

Question 35

Risk factors to calculate global risk score for hyperlipemia

Answer 35

``` Age Family history HTN Tobacco abuse Low HDL ```

Question 36

Low risk 0-1 risk start at 190 LDL to 160 Moderate 2 risk factors start at160 to 130 Moderately high 100-129 is the goal High target less than 70

Answer 36

ATP 3 guide lines