questions misc Flashcards
fonda how much heparin to give most
80 u/kg full load if GIIpIIIa then give 60 u/kg
Burr to artery ratio forrotational atherectomy
0.5 to 0.6
What is ideal rotational speed for rota
Decel speed done want to drop by?
Length of time for ablation run
WP of time do get slow or no reflow
140-150,000
> 5,000
Short less than 15 to 20 seconds
up to 2.6%
Epi in cardiac arrest
1:10,0000 soln 5-15 min
blood supple to papillary mm
e posteromedial papillary muscle has a single blood supply from the dominant vessel (usually the right coronary artery; RCA). The anterolateral papillary muscle generally has a dual blood supply and is less likely to rupture following myocardial infarction.
MB elevation level of sig post mi
CK-MB elevations above a significant threshold (5x ULN with Q waves, or 10x ULN without Q waves) have been considered to be of late significance due to their association with increased late mortality.
What is happening with neointimal hyperplasia
smooth muscle cells are proliferating into the lumen
What is the pathophys of worsening outcomes with no reflow
ischemia-reperfusion injury, which contributes to the formation of reactive oxygen species, resulting in cell injury. Intimal (not adventitial) endothelial cell edema contributes to no-reflow.
dose of atropine in ACS
when can you repeat
what is the max dose
0.5 mg repeat q3-5. max 3 mg
red vs. white thrombus
red is thrombin rich (ie in veins)
White is platelet rich typical of ACS
What is the 8765 rule
8 LM size 7 LAd 6 in the LAD and 5 in the LCX
give the JCTO score
4 groups
What esle can it predict
The J-CTO score is calculated by assigning 1 point for each of 5 parameters: calcification, tortuosity, blunt stump, occlusion length of ≥20 mm, and previously failed lesion. The J-CTO score stratifies CTOs into 4 difficulty groups: easy (score of 0), intermediate (score of 1), difficult (score of 2), and very difficult (score of ≥3). The J-CTO score can help predict the likelihood of guidewire crossing within 30 minutes, but also the likelihood of procedural success in some, but not all series (Figure 1).
Validate swedhart results ()
showed no difference in heparin vs. bival w/o GIIb/iiia
Transradial access had lower rate of bleeing
METS level for which asx person is supposed to be ok without stress/cath
4
where does the wire go during LAA closure procedure
Left upper pa to avoid it going into the LAA and causing a perf.
with ACS with patients treated in ED with enox what should you do?
en that patient received two therapeutic doses of enoxaparin most recent within the last 8 hours, repeat dosing is not required. A transition to heparin or bivalirudin would increase the risk of bleeding. An additional dose of 0.3 mg/kg IV enoxaparin should only be administered at the time of PCI to patients with non-ST-segment elevation acute coronary syndrome who have received fewer than two therapeutic SC doses or received the last SC enoxaparin dose 8-12 hours before PCI. Patients who received their last therapeutic SC dose >12 hours prior to PCI should be treated with a full dose of any established anticoagulation regimen.
2 medical Rx’s proven to reduce mortality in patients with stable CAD
Asa
statin
Two times CTA is appropriate
Appropriate use criteria have been established for the use of coronary CTA as a noninvasive imaging modality for intermediate-risk patients or when discordant findings exist
FFR effects what
Coronary flow is regulated at the arteriolar level. The hyperemic effect that allows for measurement of FFR occurs at the arteriolar level via endothelium-independent vasodilation.
dendothelium independent vasoldilation at the arteriorlar level
stages of pericardial effusion
Coronary Perforation (Ellis Classification)
Type I: Extraluminal crater without extravasation.
Type II: Pericardial or myocardial blush without contrast jet extravasation.
Type III: Free-flowing, frank extravasation through a perforation >1 mm in diameter or cavity spilling.
Time to transfer vs. lysis
120 min
facilitated pci THM
No study comparing facilitated PCI to planned PCI has demonstrated clinical benefit. Increased bleeding rates with facilitated PCI have been reported.
Roll of platelets in ACS 4 steps!.
- Adhesion - plts adhere with GpIA to VWF.
- Activation - Thrombin, ADP, 5HT, TXA2
- Aggregation - fibrinogen
- platelet plug
Simple coag Cascade
Intrinsic PAthwa Extrinsic Pathway
XIIa VIIa
XIa.
IXa
Xa
Thrombin II
Fibrin
Heparin / enox function on what
Thrombin (AT prevents these two)
TF
Plasma Clotting cascade
PRothrombin
Thrombin
fibrinogen–> fibrin—> thrombus
Absolute CI to lytics
Prior hemorrhagic stroke
Ischemic stroke within 3 months
Closed head trauma within.3 mo
IC neoplasm or AVM
Actvie internal bleeding
suspected ao dissection
5 direct thrombin inhibitors (aside from heparin and LMWHs )
Lerpirudin
Bival
Argatroban
Dabiga
heparins MOA
% of pts with HIT
makes AT work more quickly to reduce thrombin
Heparin given subq or IV
fonda protamin
doesnt work, there is partiall for lovenox
FondaparinauX
What is MOA?
Xa
Clearance of anticoagulants
UFH, LMWH, DTI –> renal
argatroban –> heaptic
HIT two types
TCP Type I benign asx < 4 days, Type II severe 4-14 days, –> Pf4 heparin complex ab
for type II Dont give plts
DTI (argatroban) no coumadin until 100-150 k
Rechalleng not until 3 months
fonda moa
indirect Xa inhbitor
T12 of bival
25 min
Protamine MOA
?
PRotamine reaction with 2 people
NPH insulin and/or fish allergy
NPH and fish allergy think
protamine rx
Any glucose therpay imrpove mort
lifestyle changes
then
SGLT2
Mitral flow diagram for surgery
1, Mitra clip GL for primary MR
- when surgery for PS rather than BAV
- how big an rvot diameter for melody valve. concern with this
- what is the other valve for PS?
- mitra clip
- subaortic or hypoplastic.
- 16 mm, can get coronary compression.
- edwards, studied in 23 and 26 mm sizes in randomized trial for melody valve. FDA approval for treatment in perc pulm valve repelacement. endocarditids more common in the melody valve. Ednocardtitis more common in meoldoy vavle.
What are the MRI indicies of RV dysfunction (4)
RDEV >150 ml/m2
RVEF < 40$
RV Regurg fraction > 35%
QRS >180 ms
