Trigger - IHD part 2

Question 1

what could a new LBBB on an EKG indicate

Answer 1

suspicious for STEMI

Question 2

what are reasons a trop can be elevated aside from MI

Answer 2

Question 3

false positive could be caused by exercise, trauma, or DM

Answer 3

CK-MB

also see: muscle disease, PE

Question 4

what EKG abnormalities make an exercise stress test contraindicated

Answer 4

• preexcitation syndrome WPW
• electronically paced ventricular rhythm
• greater than 1mm of resting ST depression
• Complete LBBB

Question 5

to increase sensitivity and specificity of a stress test, what could be added

Answer 5

Echo

Question 6

a patient has a complete LBBB on EKG. are they eligible for an exercise stress test?

Answer 6

NO. do a pharm stress test.

Question 7

adenosine, dipyridamole, regadenoson are all used for what?

Answer 7

used as vasdilative agents in pharmacological stress testing.

causes coronary artery vasodilation

Question 8

Contraindicated in patients with bronchospasms

Answer 8

Pharmacologic vasodilation agents used in stress tests (dipyrimadole, adenosine, regadenoson)

Question 9

when is dobutamine with atropine used

Answer 9

andrenergic stimulants used as second line pharmacological stress test agents

Question 10

CI in sustained arrhythmias and systemic HTN

Answer 10

dobutamine and atropine

Question 11

metformin is CI and must be held prior to what procedure

Answer 11

cardiac cath/coronoary angiogram!

Question 12

what type of consent is required in cardiac cath/ coronary angiogram

Answer 12

WRITTEN

Question 13

SE include tachycardia, increased SBP and PVCs

Answer 13

andrenergic stimulating agents (dobutamine an atropine)

also see: palps, angina, HA, nausea, dyspnea

Question 14

HR must be less than 50bpm in order to perform which test?

Answer 14

CT of the coronary arteries

Question 15

for ACS management, when should BB not be used

Answer 15

CHF
Bradycardia
AVblock

Question 16

decreases SVR and preload by dilating coronary vessels and increasing blood flow

Answer 16

MOA of NTG

also enters vascular smooth muscle and converted to nitric oxide, leading to activation of cGMP and vasodilation

Question 17

also enters vascular smooth muscle and converted to nitric oxide, leading to activation of cGMP and vasodilation

Answer 17

MOA of NTG

decreases SVR and preload by dilating coronary vessels and increasing blood flow

Question 18

first line therapy in patients with ACS except in patients with a IWMI

Answer 18

NTG

IWMI involves the RV, which will affect preload too much if treated.

Question 19

SE includes reflex tachycardia and paradoxical bradycardia. MC SE is headache, postural hypotenstion

Answer 19

NTG

Question 20

this medication decreases sympathetic tone, decreases SVR, and deceases O2 demand. therefore reducing afterload

Answer 20

morphine

Question 21

use caution in hypotension, hypovolemia, and respiratory depression

Answer 21

morphine

Question 22

used for stabilizing plaque and antiplatelet aggragation

Answer 22

ASA

Question 23

600mg of plavix is bolused prior to what procedure

Answer 23

cardiac cath

Question 24

plavix must be postponed 5 days prior to what procedure? (reminder ticagrelor is 7 days)

Answer 24

CABG

Question 25

inhibition of platlet aggregation and support of PCI for HIGH RISK PTS only. What drug?

Answer 25

Aggrastat, integrillin, reopro

glycoprotein 2b/3a inhibitors

Question 26

if pain persists, IV NTG can be given until MAP drops by how much?

Answer 26

10%

Question 27

this drug reduces infarct size, rate, cardiac remodeling and cardiac enlargement

Answer 27

BB

also deceases life threatening tachycarrhythmias

Question 28

SE of QT prolongation in this drug. Used cor chronic stable angina

Answer 28

Ranolazine (late Na channel blocker)

Question 29

reduces fibrosis and remodeling post MI

Answer 29

ACEs and ARBs

Question 30

when is alteplase and tenecteplase used

Answer 30

fibrinolytic therapy used in STEMI TX ONLY

Question 31

SE is ICH

Answer 31

tPA administration

Question 32

when is LMWH used with ASA

Answer 32

post-tPA or in surgery

Question 33

when do you use tPA

Answer 33

only when cardiac cath cannot be done within a few hours of the STEMI. ideally you want tPA administered within 30 min of ED arrival

Question 34

when are PPIs indicated

Answer 34

after the use of fibrinolytics in a STEMI

alternate options to PPI is antacids and H2 blockers while hospitalized

Question 35

what is the GOLD standard tx for unstable CAD

Answer 35

PCI

Question 36

this type of stent has a longer period of DAPT, but is still the preferred type of stent

Answer 36

drug-eluting stent

Question 37

when do you use DAPT?

Answer 37

Post PCI

P2Y12 receptor blocker + ASA for 3-12 months