MKSAP 1: Diagnostic Testing in Cardiology Flashcards
What constitutes “family history of premature CAD”?
Male < 45 years; Female < 55 years
List the attributable risks for MI from highest to lowest:
cholesterol levels current smoking psychosocial stressors T2DM HTN abd obesity no alcohol intake inadequate exercise irregular consumption of fruits/vegetables
What are the cholesterol guidelines in regards to patients with diabetes?
Moderate or high intensity statin in patients aged 40-75 with diabetes.
In patients with DM aged 40-75 with ASCVD > or equal to 7.5 -> high intensity statin
In patients with DM in same age group ASCVD < 7.5 -> moderate intensity statin
What are the grouped categories for risk using the ACC/AHA CV Risk calculator?
10 year ASCVD risk < 5%: low risk
5-7.5%: intermediate risk
> 7.5% high risk
What population of patients is the hsCRP level used?
May be used in intermediate risk patients by the Framingham risk calculator in whom choice of therapy may be affected by classification of risk.
What are the USPSTF recommendations for ASA for primary prevention of CVD? Men aged 45-79 yrs Women aged 55-79 yrs Men/women age >80 Men age<45, women <55
Men aged 45-79 yrs -> ASA recommended when benefit of reduction of MI > risk GI bleeding
Women aged 55-79 yrs -> ASA recommended when benefit of reduction of ischemic stroke > risk of GI bleeding
Men/women age > 80 yrs -> Insufficient evidence for primary prevention
Men age <45, women <55 -> ASA not recommended for prevention of MI in men or stroke in women
What is the overall goal or purpose of stress testing?
Use on patients with intermediate pre-test probability for CAD in order to reclassify them as either low or high risk.
What 2 general categories can stress tests generally be broken down into?
What are the conditions to use an exercise stress test?
Stress tests can be functional or anatomic evidence of ischemia
Intermediate risk patients who are able to exercise with a normal baseline ECG should have exercise stress testing.
What are 2 prediction models for ischemia related to mortality during an exercise stress test?
Duke Treadmill score: factors in development of symptoms, degree of ST segment depression, and exercise duration
Heart rate recovery: patients with a HR drop of <12/min in the 1st minute after cessation of exercise have higher mortality
Failing to hit 5 METS (passing the first stage of the Bruce protocol)
What are 3 values to determine if the exercise stress test is adequate?
Exercising for 6-12 minutes
Achieving 85% of age predicted maximal heart rate (220-age)
rate pressure product (HR x SBP) at least 25,000
when should stress tests be terminated?
When patient has exerted max effort and achieved 85% PMHR, patient requests to stop or experiences symptoms, or exertional hypotension, significant hypertension, ST segment elevation or depression, or ventricular or supraventricular arrythmias
What conditions prevent patients from undergoing physiologic stress testing?
Severe AS, AAA, severe HTN, or uncontrolled arrhythmias
What are the stages of coronary artery calcium scoring?
0: no disease
1-99: mild disease
100-399: moderate disease
>400: severe disease
What is the specific group of patients that a CAC score is appropriate for?
Intermediate Framingham risk score (10-20%) in whom results will influence treatment strategy?
Monitoring and diagnostic studies for cardiac arrhythmia are based on?
The frequency of the patient’s episodes.
