Trials Flashcards

1
Q

What is the Save trial Intervention In who Outcomes

A

Treat MI with ACE inhibitor. Mostly asymptomatic Reduced mi.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is stitch hypothesis 1 Who Intervention Outcomr

A

Omt vs Cabg in Ef <35. No stastical difference but in pt without angina. Lots of crossover. No survival difference with viability.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Survival differences in heart mate 2 trial

A

60% in hm2 vs 24% with xve at 2 yrs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Cumulative effect of ace inhibitors? + beta blockers + aldo blockers

A

28% 34% 15%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Solvd trial When Who Outcomes

A

1991 Ef < 35. Two trials one with sx/one no sx Enalapril 10 bid Lowered all cause mortality and death/HF hospitalizations

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Save trial Who What happened

A

Post mi Ef <40, no overt HF Placebo vs captopril Reduced cv death 21%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are the 4 bb trials RRR, inlusion

A

Us carvedilol 65 rrr, mild/mod HF Ef <3 cibis 35 mod/severe merit 35 mild/mod hf improve Ef by 30% Copernicus 35 severe Capricorn post mi

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Comet trial

A

Carvedilol va metop Much less dm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Who should get beta blockers when to start When to titrate dose?

A

Symptomatic and asymptomatic Ef <40 Initiate once euvolemic/Discontinue inotropes prior to sc Change dose every 2 week

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Elite 2 trial outcomes

A

Losartan had no benefit over captopril

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Val heft Intervention Outcomes

A

Valsartan added to ace. Reduced HF hospitalizations.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Charm alt/added

A

Charm alt had benefit Added did not

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Optimaal Intervention Outcome

A

Losartan vs captopril post mi. No difference

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Valiant Intervention Outcome

A

Post mi Valsartan v captopril No differences

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Who should get arb

A

Class 1: ace intolerant, those on Arbs already, Don’t use post mi, don’t use if on spirinolactone.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Consensus trial Intervention Outcome

A

Enalapril in stage d. Nnt 7

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Optime CHF

A

No benefit of milrinone .5 But seemed to work better in non ischemic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Corona-Gissi HF

A

No benefit of statins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Rales Population Outcome Weaknesses

A

Class iv. Nnt 9 Weakness low use bb

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Emphasis Population Intervention Nnt/rrr

A

Class ii/3 Ef<30 spirinolactone Nnt 19 rrr 15%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Ephasus Population Nnt

A

MI, Ef<35, sx of HF Nnt 44

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

How often should you measure k in pt on aldostorone

A

At week one and four and every 3 mos Don’t give k unless less than 4

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Enrollment in emphasis Primary outcome Findings rrr nnt

A

Nyha 2, ef<30 or 35 with wide qrs Cv death or hf hospitalization, Rrr 30, nnt 19

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Aheft What is endpoint?

A

Composite death, HF, qol 4 % arr Recommended for aa, with moderate to severe symptoms reasonable in ace intolerant

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Goal digoxin level

A

Less than 1.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Should patients with non ischemic cm get aspirin

A

No

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

HEAAL

A

NYHA 2-4, Ef< 40 Ace intolerant, randomized to 150 vs 50 of losartan. Higher doses reduced hospitalizations.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Shift trial

A

Class. 2-4 Decreased HF death, hospitalizations if hr > 77

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Why use swan

A

Low bp Fluid status Renal failure Vasoactive agents Advanced therapies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What’s a cross sectional study

A

Data collected at a single point in time.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Why is randomization important

A

Eliminates bias from treatment assignment Tries to remove type 1 error.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What is most important thing about clinical trial endpoints

A

If doesn’t hit primary end point must ignore secondary endpoint.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Utility of secondary endpoints

A

Only useful if statistically significant primary endpoint.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Best primary outcomes

A

Clinical outcomes Symptoms Surrogates (may not always work).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

How to do multiple primary endpoints

A

Account for alpha (type 1 error). Must decide this at the beginning.

36
Q

Point of subgroups

A

Look at them but don’t make any conclusions

37
Q

Phlebostatic axis

A

4th intercostal space Midpoint between anterior and posterior chat.

38
Q

What lung zone do you want to be in when wedge

A

Zone 3 Zone 1/2 collapse of alveolar

39
Q

When do you want to measure chambers

A

End expiration. Subtract half peep if on ventilator.

40
Q

When does wedge pressure occur

A

Look at pr V wave occurs in t p (closer to p) can look for double bump in pa to predict presence of v wave V wave a combination of volume already in la and regurgitate volume.

41
Q

Fick

A

Cardiac out= oxygen consumption/oxygen extracted Oxygen capactity = 13*hgb* av o2 difference. Guess consumption 3-4 l kilo

42
Q

Constriction versus restriction

A

Look in diastole! Constriction dip and plateu. Rvedp> 1/3 RSVP. Restriction pas > 50. Lvedp-rvedp>5

43
Q

Differentiate between restriction/constriction and tamponade

A

Tamponade loose y descent.

44
Q

Pathoneumonic finding in hcm hemodynamics

A

Spike and dome

45
Q

Class I indication for pa catheter

A

To guide therapy in patients who are in respiratory distress Or impaired perfusion but you can’t determine fluid status, Bp remains low, renal fxn worse, need vasoactive agents, support for device.

46
Q

Catheter whip

A

Tall and skinny artifact

47
Q

Best surrogate for outcomes in heart failure

A

Lv size.

48
Q

Ace inhibitors integrated recs

A

All patients ef <40 Doses should be titrated to doses used in clinical trials

49
Q

How long does it take to improve ef in beta blockers

A

3 months.

50
Q

Differences between bisoprolol, metoprolol and carvedilol

A

Bisoprolol and metoprolol much more beta one selective.

51
Q

Carvedilol vs metoprolol

A

Carvdedilol better at lower doses better in diabetics Metoprolol better in hypotensive, copd etc

52
Q

Beta blockers integrated recs

A

Beta blockers are reccomended for symptomatic and asymptomatic ef <40 Decomp: Initiate after optimizing volume status and prior to discharge.

53
Q

Elite 2 trial

A

Losartan not better than captopril

54
Q

Optimaal/Valiant

A

Post mi. No better than ace.

55
Q

Charm added

A

Only trial to show benefit of ace + arb (combine m and m).

56
Q

Who should be on arb

A

Reccommended for intolerant of ace Technically ok as alternative for ace if post mi (valiant) Do not use routinely in addition to ace post mi (valiant)

57
Q

Inclusion criteria for ephesus

A

Post mi, ef< 40, Chf or dm

58
Q

Emphasis trial

A

Nyha class ii, ef < 35%

59
Q

Arb recs

A

Class ii-iv, Ef < 35% Post mi ef 2.5, potassium >5 Avoid cyp3a4 and eplerenone.

60
Q

Hydralazine/nitrates

A

AA: moderate to severe sx (lvef <35or 45 with 6.5 cm ventricle). Reasonable for patients on ace/arb who are symptomatic

61
Q

Polypharm

A

Addition of arb (a) Addition of Aldo (a) Hydralazine/nitrates (c)

62
Q

Digoxin

A

Consider if lvef <1.0 start and .125 Ok to use in Afib, if beta blocker not working.

63
Q

Aspirin for heart failure

A

No benefit in non ischemics.

64
Q

Watch trial

A

Excluding Afib, warfarin aspirin and clopidigrel class 2-4 Ef <35 No benefit Warcef also showed no benefit.

65
Q

Drugs to avoid In HF

A

NSAIDs Ccb stage b, (negative inotropy). Only use vasoselective - amlodopine. Only can use amiodarone/dofetilide

66
Q

Warfarin

A

Amio, Bactrim, may increase Rifampin may decrease.

67
Q

What drugs are metabolized by cyp4503a4 What downregulate cyp

A

Tarolimus, statins. Dig, sirolimus, cyclosporine, eplerenone Diltiazem, amio, Bactrim, flucinazole, flagyl.

68
Q

Elderly and HF

A

Ace and bb Watch out for volume status, postural hypotension, cva

69
Q

Beta blocker guideline Contraindication

A

Contraindication if have active bronchospasm. Use with caution if hypoglycemic, asthma, resting limb ischemia

70
Q

Anemia and heart failure

A

Can cause high output HF. But takes a lot of anemia. Independentally associated with worse HF mortality. 12 better than 10.

71
Q

Epo in heart failure

A

Black box warning. Can increase stroke.

72
Q

Fair HF

A

Improved self reported symptoms with iron. No guidelines yet

73
Q

Define apnea

A

No air flow for 10 seconds despite effort 5 episodes per hour. A/h index >3 worse

74
Q

Why cheyenne stokes

A

Low co2 because breathe too fast .. Lead to vicious cycle of hypo ventilation.

75
Q

Canpap trial

A

No differences in qol, exercise intolerance etc.

76
Q

Who is bipap good for ? Nocturnal o2?

A

Bipap Good for hypoventillation not hyperventilation O2 good for hyperventilation Exercise training. Bb and CRT work

77
Q

Sad hart

A

Zoloft or placebo No benefit

78
Q

Effexor

A

May increase Bp Wellbutrin can also increase Bp Celexa bad qt

79
Q

Discharge instructions?

A

Meds Diet Activity Weight What to do if Follow up appointment call within 3 days and clinic within 7 days.

80
Q

Number one reason for readmission in optimize HF

A

Arrhythmia.

81
Q

What predicts outcomes in HF

A

Readmission, renal disease (creat Clarence >60).

82
Q

Rules for starting Aldosterone Antogonists

A

Modererate to Severe Sx

Creatinine <2 in women, 2.5 in men

K <5

DO NOT START IF PATIENT IS NOT COMPLIANT.

83
Q
A

Cardiac amyloid

84
Q
A

Sardcoid

85
Q
A

Myocarditis

86
Q
A

Episioon wave

87
Q
A