questions misc Flashcards

1
Q

fonda how much heparin to give most

A

80 u/kg full load if GIIpIIIa then give 60 u/kg

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2
Q

Burr to artery ratio forrotational atherectomy

A

0.5 to 0.6

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3
Q

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

A

140-150,000

> 5,000

Short less than 15 to 20 seconds

up to 2.6%

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4
Q

Epi in cardiac arrest

A

1:10,0000 soln 5-15 min

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5
Q

blood supple to papillary mm

A

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.

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6
Q

MB elevation level of sig post mi

A

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.

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7
Q

What is happening with neointimal hyperplasia

A

smooth muscle cells are proliferating into the lumen

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8
Q

What is the pathophys of worsening outcomes with no reflow

A

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.

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9
Q

dose of atropine in ACS

when can you repeat

what is the max dose

A

0.5 mg repeat q3-5. max 3 mg

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10
Q

red vs. white thrombus

A

red is thrombin rich (ie in veins)

White is platelet rich typical of ACS

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11
Q

What is the 8765 rule

A

8 LM size 7 LAd 6 in the LAD and 5 in the LCX

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12
Q

give the JCTO score

4 groups

What esle can it predict

A

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).

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13
Q

Validate swedhart results ()

A

showed no difference in heparin vs. bival w/o GIIb/iiia

Transradial access had lower rate of bleeing

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14
Q

METS level for which asx person is supposed to be ok without stress/cath

A

4

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15
Q

where does the wire go during LAA closure procedure

A

Left upper pa to avoid it going into the LAA and causing a perf.

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16
Q

with ACS with patients treated in ED with enox what should you do?

A

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.

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17
Q

2 medical Rx’s proven to reduce mortality in patients with stable CAD

A

Asa

statin

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18
Q

Two times CTA is appropriate

A

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

19
Q

FFR effects what

A

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

20
Q

stages of pericardial effusion

A

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.

21
Q

Time to transfer vs. lysis

A

120 min

22
Q

facilitated pci THM

A

No study comparing facilitated PCI to planned PCI has demonstrated clinical benefit. Increased bleeding rates with facilitated PCI have been reported.

23
Q
A
24
Q

Roll of platelets in ACS 4 steps!.

A
  1. Adhesion - plts adhere with GpIA to VWF.
  2. Activation - Thrombin, ADP, 5HT, TXA2
  3. Aggregation - fibrinogen
  4. platelet plug
25
Q

Simple coag Cascade

A

Intrinsic PAthwa Extrinsic Pathway

XIIa VIIa

XIa.

IXa

Xa

Thrombin II

Fibrin

26
Q

Heparin / enox function on what

A

Thrombin (AT prevents these two)

TF

Plasma Clotting cascade

PRothrombin

Thrombin

fibrinogen–> fibrin—> thrombus

27
Q

Absolute CI to lytics

A

Prior hemorrhagic stroke

Ischemic stroke within 3 months

Closed head trauma within.3 mo

IC neoplasm or AVM

Actvie internal bleeding

suspected ao dissection

28
Q

5 direct thrombin inhibitors (aside from heparin and LMWHs )

A

Lerpirudin

Bival

Argatroban

Dabiga

29
Q

heparins MOA

% of pts with HIT

A

makes AT work more quickly to reduce thrombin

Heparin given subq or IV

30
Q

fonda protamin

A

doesnt work, there is partiall for lovenox

31
Q

FondaparinauX

What is MOA?

A

Xa

32
Q

Clearance of anticoagulants

A

UFH, LMWH, DTI –> renal

argatroban –> heaptic

33
Q

HIT two types

A

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

34
Q
A
35
Q

fonda moa

A

indirect Xa inhbitor

36
Q

T12 of bival

A

25 min

37
Q

Protamine MOA

A

?

38
Q

PRotamine reaction with 2 people

A

NPH insulin and/or fish allergy

39
Q

NPH and fish allergy think

A

protamine rx

40
Q

Any glucose therpay imrpove mort

A

lifestyle changes

then

SGLT2

41
Q

Mitral flow diagram for surgery

A
42
Q

1, Mitra clip GL for primary MR

  1. when surgery for PS rather than BAV
  2. how big an rvot diameter for melody valve. concern with this
  3. what is the other valve for PS?
A
  1. mitra clip
  2. subaortic or hypoplastic.
  3. 16 mm, can get coronary compression.
  4. 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.
43
Q

What are the MRI indicies of RV dysfunction (4)

A

RDEV >150 ml/m2

RVEF < 40$

RV Regurg fraction > 35%

QRS >180 ms

44
Q
A