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General Cardiology Boards > Mayo DVDs > Flashcards

Mayo DVDs Flashcards

1
Q

Goal A1c for pt with CAD

A
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2
Q

Best candidates for prasugrel

A
  1. No prev CVA

2. Age 60kg

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3
Q

DDx for coronary artery causes of CAD

A
  1. CAD - atherosclerosis
  2. Coronary Artery Spasm
  3. Takatsubo
  4. Spont Coronary Artery Spasm
  5. Microvascular Disease (Amyloid)
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4
Q

How to give P2Y12 after fibrinolysis

A

1) If received loading dose of P2Y12 give Plavix 300 unless >75yo then 75mg
2) If no loading dose and PCI within 24 hours load with Plavix 300
3) If no loading dose and PCI after 24 hours - Plavix 600 or prasugrel 60

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5
Q

What is evidence for IV beta blocker in ACS

A
  1. Lower rates of recurrent MI and VF
  2. Higher rates of cardiogenic shock
  3. IIa for pt with refractory HTN or ongoing ischemia
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6
Q

Class I indication for oral ACE in ACS

A
  1. Ant STEMI

2. LVEF

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7
Q

When to assess traditional risk factors for CAD?

When to estimate 10 year risk?

A
  1. Q4-6 years in adults 20-79 years

2. Q4-6 years adults 40-79 years w/o ASCVD.

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8
Q

When to use pooled cohort equation

A

10 year risk in Af Americans and non-Hispanic whites 40-79 years of age

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9
Q

Which statin least likely to increase incidence of diabetes

A

pravastatin

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10
Q

Jupiter trial showed

A

Men 50 years of age or older or Women 60 years of ae or older with LDL

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11
Q

Definition of metabolic syndrome (3 or more)

A

1) Men waist circumference >102cm, Women >88cm
2) TG > 150 or drug treatment
3) HDL 130/85 or drug treatment
5) Fasting glucose >100 or drug treatment

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12
Q

High intensity statin

A

Atorva 40 or 80

Rosuva 20 or 40

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13
Q

Secondary causes of dyslipidemia

A

1) Hypothyroidism (LDL and TG elevated)
2) Obstructive Liver Disease (LDL, HDL, LpX)
3) Uncontrolled DM (elevated TG, lowered HDL)
4) Nephrotic Syndrome ( elevated LDL/TG)
5) Renal Failure (elevated LDL/TG, decreased HDL)

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14
Q

Drugs that cause dyslipidemia

A

1) Androgenic Steroids (low HDL, high LDL)
2) Progestogens/Estrogens (elevated HDL/TG)
3) Retinoic Acid (elevated TG)
4) Corticosteroids (elevated LDL/TG)
5) Protease inhibitors (elevated TG/LDL, decreased HDL)
6) Thiazide diuretics (elevated LDL/TG)
7) Beta blockers (elevated LDL/TG)

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15
Q

Statins metabolized by CP450 3A4

A

Simva, Atorva, Lovastatin.

Avoid protease inhibitors, antifungals, niacin, antibiotics, grapefruit juice

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16
Q

Statins with less drug drug interactions

A

1) Fluva and Rosuva - Cyp P450 but 2C9 rather than 3A4

2) Prava - not metabolized by Cyp P450

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17
Q

Max dose of Simva for the following drugs

1) Amiodarone
2) Verapamil
3) Diltiazem
4) Amlodipine
5) Ranolazine

A

1) 10
2) 10
3) 10
4) 20
5) 20

18
Q

TG > 500 associated with

A

pancreatitis

19
Q

Causes of low HDL

A

Smoking, obesity, physical inactivity, Diabetes, High carb diet, androgenic steroids

20
Q

Goal of weight loss therapy

A

reduce body weight by 5-10% from baseline.

21
Q

Contraindications to use of aldosterone antagonist

A

Cr > 2.5 in men, Cr > 2 in women. K > 5

22
Q

Duke treadmill score

A

Treadmill time - (5xST dev) - (4xAngina index(0,1,2))
5 or greater is low risk.
Less than or equal to -11 is high risk

23
Q

Components of TIMI risk score

A
  1. Age over 65
  2. Greater than or equal to 3 CAD risk factors
  3. Prior CAD
  4. Aspirin use
  5. More than 2 angina episodes in 24 hours
  6. ST segment deviation
  7. Positive biomarkers
24
Q

Guideline definition of STEMI

A
  1. ST segment elevation of greater than or equal to 0.1 mV in 2 or more contiguous leads (men ≥ 0.2 or women ≥ 0.15 in V2-3)
  2. New left bundle branch block
25
Q

What is the difference between rescue PCI and a pharmaco-invasive strategy and facilitated PCI

A
  • Rescue PCI is when lytics fail.
  • Pharmaco echo invasive strategy is an elective angiography plus minus PCI after lytics
  • Lytic or IIb/IIIa plus immediate PCI (this is class III)
26
Q

What percentage of patients receiving thrombolytics will achieve TIMI-3 flow

A

50%

27
Q

Absolute contraindications to fibrinolysis

A
  1. Any prior IC hemorrhage
  2. Known structural cerebral vascular disease (AVM, aneurysm)
  3. Malignant intracranial neoplasm
  4. Ischemic CVA
28
Q

While at his goal time to revascularization to consider if appropriate to transfer versus lyse

A

120 minutes

29
Q

What is role of IV beta-blocker ACS

A

Contraindicated

30
Q

Ticagrelor side effects from Plato trial

A
  1. Ventricular pauses greater than 3 seconds in first week
  2. Dyspnea
  3. Reversible rise in Cr
  4. CI w Hx ICH
  5. CI severe hepatic impairment
31
Q

Indications for IIb/IIIa

A

IIa - recur is give me discomfort despite aspirin, P2Y12, heparin.
IIb - high-risk and NSTEMI (+ trop, DM, sig ST depression)

32
Q

What is mechanism of bivalirudin

A

Direct thrombin

33
Q

New murmur in supine patient vs. new murmur in pt sitting upright

A

Supine - VSD

Upright - Acute MR

34
Q

High risk stress ECHO features

A
  1. severe resting or stress ↓EF
  2. wall motion abnormality > 5 segments
  3. wall motion abnormality >2 segments at low dose dobutamine (≤ 10mg/kg/min) or at low heat rate (
35
Q

How long to wait for surgery post POBA? BMS? DES?

A
  1. POBA 14 days
  2. BMS 30-45 days
  3. DES 365 days
36
Q

Components to making diagnosis of acute pericarditis

A

history, ECG, ↑ESR, rub

  • ECHO only if ↑JVP or CHF
  • Autoimmune workup if recurrent
  • Biomarkers if CAD suspected or myocarditis
37
Q

Acute pericarditis management

A
  1. NSAID for 1 month (Class I)
  2. Colchicine for upto 3 months (Class I)
  3. Avoid Steroids (Class IIa to use with long taper to NSAID + Colchicine in recurrent patients)
  4. Pericardiectomy (Class IIa for recurrent - may still have pain post surgery)
38
Q

Steep x and y descent. (Collapsing neck veins)

A

Constrictive pericarditis

39
Q

How to radiographically diagnose constriction

A

thickening of pericardium on CT (80%) or CXR (25%)

40
Q

Pericardial cyst treatment

A

usually benign. Only resect if compressing

41
Q

causes of pericardial malignancy

A

lung, breast, esophagus, hematologic, melanoma

42
Q

worst prognosis for constrictive pericarditis

A

hx of radiation

General Cardiology Boards (2 decks)

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