Post ACS care / Stable CAD

Question 1

In patients with post GI bleed and new sent (so on DAPT) you should start:

Answer 1

PPI as it decreases risk for upper GI bleed.

prefer protonix

Question 2

Potential interaction between PPI and clopidogrel (Plavix)

Answer 2

PPI may stop CYP219 metabolism which may decrease efficacy of P2Y12 receptor blocker clopiogren in preventing stent thrombosis.

Question 3

when to start spironolactone in someone post ACS and post stent?

Answer 3

Only start when symptomatic heart failure w/ LV EF <35%

Question 4

Indications for starting PPI in patients who have to be on DAPT

Answer 4

prior upper GI bleeding, pud, active H pylori infection, >65 yrs.

Question 5

after fibrinolysis in acute STEMI and successful reperfusion, what is the next most appropriate step?

Answer 5

need to transfer to a PCI capable location due to possible reocclusion (happens in 20% of cases) over the next few hours.

Question 6

indications for a implantable cardioverter defibrillator placement for primary prevention

Answer 6

primary prevention:  prior MI and LVEF<30% 
NYHA class II or III symptoms and LVEF<35%

Question 7

indications for a implantable cardioverter defibrillator placement for secondary prevention

Answer 7

prior VT or unstable VT without reversible cause

prior sustained VT with underlying cardiomyopathy

Question 8

When should a patient be assessed for AICD placement post MI especially if there’s akinesis of myocardium post MI?

Answer 8

need to be reassessed after 3 months of coronary revascularization. because of myocardial stunning and chance for recovery and improvement in EF.

Question 9

if patient who has STEMI doesn’t undergo coronary revascularization, when should they be reassessed for ICD placement?

Answer 9

40 days following MI.