Other

Question 1

Management of Cocaine STEMI?

What (2 Medications) are to be Avoided in Cocaine-induced STEMI and Why?

Answer 1

Immediate PCI

Fibrinolytics - due to increased intracranial hemorrhage risk with Cocaine

Beta blockers- due to unopposed alpha 1 stimulation

Question 2

1. 1st line treatment for PAD?
2. What is an alternative to this medication if they dont tolerate it ?
3. 2nd line treatment for PAD?
   What is another indication for this medication?
4. Contradictions and Why?
5. Indications for Revascularization?

Answer 2

1. ASA
2. Clopidegrol
3. Cilostazol (2nd line)
   • Used for persistent PAD Symptoms despite ASA & Excercise

         Also 

Given for patients who dont meet Revascularization Criteria ( they have ABI > 0.5)

4.. Cilostazol - Contraindicated in Heart failure since its a Phosphodiesterase Inhibitor (Lower BP Vasodilates) - increase mortality

5. When patients:
   *Fail medical treatment and exercise
   *Significant disabling symptoms
   *Limb threatening ischemia

Question 3

Patients with typical Claudication symptoms and Normal ABI.

Next step in management ?

Answer 3

Do Exercise testing with Repeat ABI to confirm Occlusive PAD

• The artery is so occuluded there is no passage of flow

“Stress test the leg”

Question 4

Who needs Stress Testing as Pre-op?

Answer 4

Patients with Known or Suspected CAD

or

Undergoing High-Risk Surgery (Vascular surgery).

Question 5

Complications Post Cardiac Catherization?

Management of Pseudoaneurysm?

Answer 5

Hematoma
Arterial dissection
Thrombosis
Pseudoaneurysm
AV fistula
RP bleed

Ultrasound-Guided Compression or Ultrasound-guided Thrombin Injection- to help plug up clot

Question 6

In-Stent Thrombosis usually manifests as a STEMI within the 1st after stent Placement. What is the cause?

Answer 6

premature discontinuation of antiplatelet therapy.

Question 7

Antibiotic prophylaxis is only recommended for which procedures?

Whats the Antibiotic Regime?

Answer 7

Antibiotic prophylaxis

High-risk condition + Dental work involving GINGIVAL manipulation or a Respiratory Tract procedure with Incision/Biopsy.

Oral amoxicillin 2 grams administered 30-60 minutes before the procedure

Question 8

Medical management of Aortic Dissection?

Why isnt hydralazine a good choice?

Answer 8

IV labetolol or IV Esmolol to help get the pressure < 120mm hg and if that doesn’t help add Nitroprusside

It Has Enhanced Reflex sympathetic tone which can exacerbate the dissection from the sheer stress.

Question 9

Management of Acute STEMI

What if PCI CANT be done in 90 minutes?

Answer 9

1. Asa
2. Plavix
3. Heparin
4. Send to PCI within 12 hrs of Symptom onset and if PCI can be done in 90 minutes

Thrombolysis and PCI Hospital within 120 minutes

Question 10

Patient been on DAPT therapy < 6 months but needs emergency surgery ?

What if neurosurgery is specifically planned ?

Patient has been on DAPT therapy for < 6 months and elective surgery is planned ?

Answer 10

Do the surgery and continue DAPT or at least Aspirin alone

If Neurosurgery or High Bleeding Risk than STOP both.

Postponement of Surgery: Elective NonCardiac surgery should be postponed for at least 6 months after stent placement.

*Drug Continuation: DAPT or Aspirin alone should be continued throughout the perioperative period to minimize the risk of stent thrombosis.