Mayo DVDs Flashcards
Goal A1c for pt with CAD
Best candidates for prasugrel
- No prev CVA
2. Age 60kg
DDx for coronary artery causes of CAD
- CAD - atherosclerosis
- Coronary Artery Spasm
- Takatsubo
- Spont Coronary Artery Spasm
- Microvascular Disease (Amyloid)
How to give P2Y12 after fibrinolysis
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
What is evidence for IV beta blocker in ACS
- Lower rates of recurrent MI and VF
- Higher rates of cardiogenic shock
- IIa for pt with refractory HTN or ongoing ischemia
Class I indication for oral ACE in ACS
- Ant STEMI
2. LVEF
When to assess traditional risk factors for CAD?
When to estimate 10 year risk?
- Q4-6 years in adults 20-79 years
2. Q4-6 years adults 40-79 years w/o ASCVD.
When to use pooled cohort equation
10 year risk in Af Americans and non-Hispanic whites 40-79 years of age
Which statin least likely to increase incidence of diabetes
pravastatin
Jupiter trial showed
Men 50 years of age or older or Women 60 years of ae or older with LDL
Definition of metabolic syndrome (3 or more)
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
High intensity statin
Atorva 40 or 80
Rosuva 20 or 40
Secondary causes of dyslipidemia
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)
Drugs that cause dyslipidemia
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)
Statins metabolized by CP450 3A4
Simva, Atorva, Lovastatin.
Avoid protease inhibitors, antifungals, niacin, antibiotics, grapefruit juice
Statins with less drug drug interactions
1) Fluva and Rosuva - Cyp P450 but 2C9 rather than 3A4
2) Prava - not metabolized by Cyp P450
Max dose of Simva for the following drugs
1) Amiodarone
2) Verapamil
3) Diltiazem
4) Amlodipine
5) Ranolazine
1) 10
2) 10
3) 10
4) 20
5) 20
TG > 500 associated with
pancreatitis
Causes of low HDL
Smoking, obesity, physical inactivity, Diabetes, High carb diet, androgenic steroids
Goal of weight loss therapy
reduce body weight by 5-10% from baseline.
Contraindications to use of aldosterone antagonist
Cr > 2.5 in men, Cr > 2 in women. K > 5
Duke treadmill score
Treadmill time - (5xST dev) - (4xAngina index(0,1,2))
5 or greater is low risk.
Less than or equal to -11 is high risk
Components of TIMI risk score
- Age over 65
- Greater than or equal to 3 CAD risk factors
- Prior CAD
- Aspirin use
- More than 2 angina episodes in 24 hours
- ST segment deviation
- Positive biomarkers
Guideline definition of STEMI
- 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)
- New left bundle branch block
What is the difference between rescue PCI and a pharmaco-invasive strategy and facilitated PCI
- 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)
What percentage of patients receiving thrombolytics will achieve TIMI-3 flow
50%
Absolute contraindications to fibrinolysis
- Any prior IC hemorrhage
- Known structural cerebral vascular disease (AVM, aneurysm)
- Malignant intracranial neoplasm
- Ischemic CVA
While at his goal time to revascularization to consider if appropriate to transfer versus lyse
120 minutes
What is role of IV beta-blocker ACS
Contraindicated
Ticagrelor side effects from Plato trial
- Ventricular pauses greater than 3 seconds in first week
- Dyspnea
- Reversible rise in Cr
- CI w Hx ICH
- CI severe hepatic impairment
Indications for IIb/IIIa
IIa - recur is give me discomfort despite aspirin, P2Y12, heparin.
IIb - high-risk and NSTEMI (+ trop, DM, sig ST depression)
What is mechanism of bivalirudin
Direct thrombin
New murmur in supine patient vs. new murmur in pt sitting upright
Supine - VSD
Upright - Acute MR
High risk stress ECHO features
- severe resting or stress ↓EF
- wall motion abnormality > 5 segments
- wall motion abnormality >2 segments at low dose dobutamine (≤ 10mg/kg/min) or at low heat rate (
How long to wait for surgery post POBA? BMS? DES?
- POBA 14 days
- BMS 30-45 days
- DES 365 days
Components to making diagnosis of acute pericarditis
history, ECG, ↑ESR, rub
- ECHO only if ↑JVP or CHF
- Autoimmune workup if recurrent
- Biomarkers if CAD suspected or myocarditis
Acute pericarditis management
- NSAID for 1 month (Class I)
- Colchicine for upto 3 months (Class I)
- Avoid Steroids (Class IIa to use with long taper to NSAID + Colchicine in recurrent patients)
- Pericardiectomy (Class IIa for recurrent - may still have pain post surgery)
Steep x and y descent. (Collapsing neck veins)
Constrictive pericarditis
How to radiographically diagnose constriction
thickening of pericardium on CT (80%) or CXR (25%)
Pericardial cyst treatment
usually benign. Only resect if compressing
causes of pericardial malignancy
lung, breast, esophagus, hematologic, melanoma
worst prognosis for constrictive pericarditis
hx of radiation
