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Cardiology Med-Study > Lecture 3: Acute Coronary Disease > Flashcards

Lecture 3: Acute Coronary Disease Flashcards

1
Q

STEMI equivalents

A
  1. ST elevation 2 mm in continguous leads
  2. new LBB + HF/Decompensated
  3. new LBB + Stabrosso criteria
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2
Q

Location anterior, artery

A

V1-V4, LAD

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3
Q

location lateral, artery

A

Lcx

V5, V6, 1, avL

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4
Q

location inferior, artery

A

II, III, avF

RCA

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5
Q

location, right, artery

A

RCA

V4R

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6
Q

location, posterior, artery

A

PDA,

V1-2 (ST depression) —> place V7,8,9 posteriorly

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7
Q

contraindications to nitrates (6)

A
  • recent intake of sidenafil/varden < 24 hours
  • recent intake of tadalafil < 48 hours
  • severe aortic stenosis
  • HCM
  • RV infarction
  • SBP < 90 or 30 mmHg below baseline
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8
Q

acute tx

A 
MONA BASH
Morphine
Oxygen (< 90%)
Nitrates (make sure no CI)
ASA + 
BB
antiplatletet (P2y12ADP)
statin
IV heparin
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9
Q

TIMI

A

Age ≥ 65 years,
Markers (elevated cardiac markers)
ECG (ST-segment depression at presentation)
Risk Factors (3 or more cardiovascular risk factors)
Ischemic chest pain (at least 2 or more anginal events in the previous 24hrs)
Coronary stenosis (prior stenosis of 50% or more)
Aspirin (aspirin usage in the past 7 days)

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10
Q

low timi

A

0-2

other test

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11
Q

high timi

A

3-4, 4-7

early invasive

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12
Q

GRACE

A

> 140 cath

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13
Q

what are the pGY12 inhibitors and one word associations

A

clopidogrel (TTP)
prasugrel (PCI)
Ticegralor (dyspnea)

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14
Q

at the time of PCI, main effect

A

abciximab (IIb/IIIa) , thrombocytopenia

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15
Q

what are the exceptions cocaine/meth MI

A
  1. in acute intoxication - don’t give BB (unopposed alpha)

2. Benzo + nitroglycerin and relax them (reduce HTN/Tachycardia reduced load)

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16
Q

difference between NSTEMI and STEMI managemnt

A
  1. ACE/ACE-I early if EF < 40

2. No timi - straight to cath

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17
Q

contraindications for ACE/Aldosterone

A
  • K > 5.0
  • Cr > 2.5
  • concomittant K+ sparing diuretic (amiloride) or K+ supplement
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18
Q

RV MI mnemonic

A

Right on, CHER

C: Clear lung fields
H: hypotension
E: elevated JVP
R: RV infarction

Ask for Right sided leads

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19
Q

TX RV MI

A
  1. Fluids

2. Dobutamine

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20
Q

PE tamponade

A

BECK triad at the HELM
H: Hypotension
El: elevated JVP
M: Muffled heart sounds

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21
Q

Tx Vfib

A
  • unstable: shock

- stable: Amiodarone

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22
Q

ICD indications

A
  1. LEVF < 35% @ 40 days non-revasc

2. 90 days post MI (revasc)

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23
Q

tx of heart failure

A 
reduce preload (diuretics) and afterload (nitrates, ACE inhibitors) 
intra-aortic balloon counterpulsation
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24
Q

Physical exam ventricular septal infarct

A

new loud holosystolic murmur

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25
Q

timing of ventricular septal infarct

A

3-7 days

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26
Q

PE mitral reguritation

A

pulmonary edema

loud systolic murmur

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27
Q

tx of LV thrombus

A

use of therapeutic warfarin for 3 to 6 months following myocardial infarction to reduce the risk of stroke or systemic embolization

28
Q

CABG indications

A
  1. left main disease 2. multivessel CAD with or without proximal left anterior descending stenosis
    concomitant left ventricular systolic dysfunction and/or diabetes mellitus
29
Q

classic echo in Takasubo

A

presence of mid-wall and apical wall motion abnormalities with sparing of the basal segments

30
Q

stress testing in diabetics

A

recommends stress testing in patients with diabetes who are (1) symptomatic, (2) initiating an exercise program, or (3) known to have CAD and have not had a recent (>2 years) stress test.

31
Q

contraindications of ranolzine

A 
Strong inhibiters CYP3A NP Kicks RANDY
N: Nefazodone
P: protease inhibiors
KICks: Ketoconazole, itraconazole, Clarithomycin/cyclosporin
RANDY: RANolazine
32
Q

CI to BB

A

β-Blockers are contraindicated in patients with symptomatic bradycardia, high-grade atrioventricular block, acute decompensated heart failure, and severe reactive airways disease

33
Q

BP CAD goal

A

130/80

34
Q

High intensive statin groups

A

(1) LDL cholesterol level of 190 mg/dL (4.92 mmol/L) or greater; (2) diabetes mellitus; or (3) greater than 7.5% estimated 10-year risk of atherosclerotic cardiovascular disease (ASCVD).

35
Q

role of ezetamide

A

Ezetimibe may be added to moderate-intensity statin therapy when high-intensity therapy is not tolerated or has not resulted in adequate LDL cholesterol level reduction;

36
Q

best BB

A

carvedilol
metoprolol succinate (sustained release)
bisoprolol

37
Q

first line antianginal agents

A

β-Blockers and nitrates are first-line antianginal agents

38
Q

second line therapy antianginal

A

CCB -

intolerant of BB or continued symtoms.

39
Q

CCB contraindication

A

contraindicated in patients with left ventricular systolic dysfunction or advanced atrioventricular block.

40
Q

third line antiaginal, contraindications

A

Ranolzine contraindicated in patients with left ventricular systolic dysfunction or advanced atrioventricular block.

41
Q

NOAC holding before cath

A

24 hours

42
Q

fractional flow reserve

A

< 0.8 –> needs PCI

43
Q

delaying elective surgery

A
  1. 30 days BMS
  2. 6 m-1 y. DES in DES
  3. 1 year if ACS
44
Q

urgent surgery, holding PGY2 and ASA

A

continue ASA

hold PGY2 for 5 days prior

45
Q

syndrome X

A

epicardial small perforating arterial disease, not seen on main arteries on coronary angio - diabetics.
good prognosis

Patients with cardiac syndrome X have

Typical angina that is relieved by rest or nitroglycerin
Normal coronary arteriograms (eg, no atherosclerosis, embolism, or inducible arterial spasm)

46
Q

which murmors do you want to avoid nitrates in

A

HCM and severe aortic stensois

47
Q

TIMI risk score

A 
AMERICA
A: Age > 65
M: Markers elevated
EKG (elevated)
R: risk factors > 3
I: Ischemia, >2 anginal episodes
C: CAD
A: ASA use in prior 7 days
48
Q

low TIMI

A

0-2: ischemia guid

49
Q

high TIMI

A

> 2: early invasive

50
Q

bad GRACE

A

> 140

51
Q

shortness of breath on Brillita

A

directly related to drug - switch to clopidogrel

52
Q

PCI time

A

90, 120 if you have to transfer

53
Q

who gets BMS

A

cannot comply with 1 year dual antiplatelet
high bleeding risk
invasive or surgical procedure in next year

54
Q

ACS time stent

A

X 365 days

55
Q

stable – stent

A

DES: 365
BMS: 1 month

56
Q

which STEMI artery is associated with papillary muscle rupture

A

RCA

57
Q

post MI ICD

A

40 days post MI (non-revasc) or 90 days Post MI (resvasc)

58
Q

absolute contraindications to fibrinolysis

A
  1. Any prior ICH
  2. Known structural lesion in brain or malignant neoplasm
  3. ischemic stroke within 3 months
  4. suspected aortic dissection
  5. Active bleeding
  6. significant closed-head or facial trauma in the last 3 months
59
Q

onset of symptoms of fibrinolysis

A

< 12 hours

60
Q

stable angina tx

A

1) BB
2) CCB
3) Nitrates
- -< if not controlled on max therapy think about ADDING ranolazine

61
Q

nitrate tolerance

A

refractory chest pain in patients taking chronic nitrate therapy - need nitrate free thereapy

62
Q

what is peri-infarction pericarditis and tx

A

PIP is within days of MI and seen in patient with no reperfusion. Usually self-lmiting,
Tx with high dose ASA
650 to 1000 mg TID

63
Q

what is Dressler’s syndrome and tx

A

postcardiac injury - often weeks to months, NSAIDS/steroids like normal pericarditis

64
Q

BB for HF

A

carvedilol
metropolol succi
bisoprolol

65
Q

holding NOAC before angio

A

24 hours

66
Q

indidications for CABG

A
  1. LMAIN

2. 3VD with proximal lad + DM/low EF

Cardiology Med-Study (9 decks)

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