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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
timing of ventricular septal infarct
3-7 days
26
PE mitral reguritation
pulmonary edema | loud systolic murmur
27
tx of LV thrombus
use of therapeutic warfarin for 3 to 6 months following myocardial infarction to reduce the risk of stroke or systemic embolization
28
CABG indications
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
classic echo in Takasubo
presence of mid-wall and apical wall motion abnormalities with sparing of the basal segments
30
stress testing in diabetics
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
contraindications of ranolzine
``` Strong inhibiters CYP3A NP Kicks RANDY N: Nefazodone P: protease inhibiors KICks: Ketoconazole, itraconazole, Clarithomycin/cyclosporin RANDY: RANolazine ```
32
CI to BB
β-Blockers are contraindicated in patients with symptomatic bradycardia, high-grade atrioventricular block, acute decompensated heart failure, and severe reactive airways disease
33
BP CAD goal
130/80
34
High intensive statin groups
(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
role of ezetamide
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
best BB
carvedilol metoprolol succinate (sustained release) bisoprolol
37
first line antianginal agents
β-Blockers and nitrates are first-line antianginal agents
38
second line therapy antianginal
CCB - | intolerant of BB or continued symtoms.
39
CCB contraindication
contraindicated in patients with left ventricular systolic dysfunction or advanced atrioventricular block.
40
third line antiaginal, contraindications
Ranolzine contraindicated in patients with left ventricular systolic dysfunction or advanced atrioventricular block.
41
NOAC holding before cath
24 hours
42
fractional flow reserve
< 0.8 --> needs PCI
43
delaying elective surgery
1. 30 days BMS 2. 6 m-1 y. DES in DES 3. 1 year if ACS
44
urgent surgery, holding PGY2 and ASA
continue ASA | hold PGY2 for 5 days prior
45
syndrome X
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
which murmors do you want to avoid nitrates in
HCM and severe aortic stensois
47
TIMI risk score
``` 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
low TIMI
0-2: ischemia guid
49
high TIMI
> 2: early invasive
50
bad GRACE
> 140
51
shortness of breath on Brillita
directly related to drug - switch to clopidogrel
52
PCI time
90, 120 if you have to transfer
53
who gets BMS
cannot comply with 1 year dual antiplatelet high bleeding risk invasive or surgical procedure in next year
54
ACS time stent
X 365 days
55
stable -- stent
DES: 365 BMS: 1 month
56
which STEMI artery is associated with papillary muscle rupture
RCA
57
post MI ICD
40 days post MI (non-revasc) or 90 days Post MI (resvasc)
58
absolute contraindications to fibrinolysis
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
onset of symptoms of fibrinolysis
< 12 hours
60
stable angina tx
1) BB 2) CCB 3) Nitrates - -< if not controlled on max therapy think about ADDING ranolazine
61
nitrate tolerance
refractory chest pain in patients taking chronic nitrate therapy - need nitrate free thereapy
62
what is peri-infarction pericarditis and tx
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
what is Dressler's syndrome and tx
postcardiac injury - often weeks to months, NSAIDS/steroids like normal pericarditis
64
BB for HF
carvedilol metropolol succi bisoprolol
65
holding NOAC before angio
24 hours
66
indidications for CABG
1. LMAIN | 2. 3VD with proximal lad + DM/low EF

Cardiology Med-Study (9 decks)

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