Management of IHD - Walters and Kostner

Question 1

what is the treatment for severely elevated triglycerides?

Answer 1

niacin and fibrates are the drugs of choice

Question 2

what is the difference between stent restenosis and in stent thrombosis?

Answer 2

restenosis is scar tissue formation, which impairs on the patency of the lumen this is in contrast to thrombotic deposition within the stent

Question 3

what is the deal with drug eluting stents? what drug do they “elute” and what does it treat?

Answer 3

DES is all about restenosis - that is, trying to prevent scar tissue growing around the stent and leading to loss of vascular patency the original drug was rapamycin - an immunomodulator. You may recall that mTOR-inhibitors (they do the same as rapamycin)

Question 4

the FREEDOM trial was a landmark study that looked at diabetics and PCI vs CABG. what did it show overall?

Answer 4

Overall effect - diabetics requiring revascularisation of >1 lesion >69% stenosis in a major epicardial vessel require CABG

MACCE (major adverse cardiac or cerebral event) numbers were higher with PCI, particularly because of need to re-study in the PCI arm.

Question 5

what should be your evaluation of suspected coronary artery disease?

Answer 5

see image

stress echo is a good gatekeeper for deciding which angiogram you should proceed to

Question 6

Which one of the following findings during a stress exercise ECG test is most predictive of angiographically significant multivessel or left main coronary artery disease?

A. Late-onset of ST-segment depression.
B. Return to normal of ST-segment changes early in recovery phase.
C. ST-segment elevation in lead aVR.
D. Multifocal premature ventricular contractions.
E. Failure to increase systolic blood pressure by at least 10 mmHg.

Answer 6

the answer in this example is E