1-100 Flashcards
what is the most appropriate management for a patient with infective endocarditis and acute HF?
urgent cardiac surgery +diuretica +AB
The next step in management for a patient who is not responsive to escalating
doses of oral diuretics is to
administer intravenous diuretics.
Current guidelines recommend thrombolytic therapy for patients with STsegment elevation myocardial infarction (STEMI) who present within
12 hours after symptom onset when primary percutaneous coronary intervention (PCI)
cannot be performed within 2 hours after first medical contact.
Criteria for
successful thrombolysis include
improvement or relief of pain, >50% resolution in the magnitude of ST-segment elevation, and reperfusion arrhythmias (e.g., accelerated idioventricular rhythm).
Patients with new-onset heart failure and a high likelihood of coronary artery disease who are candidates for coronary revascularization should undergo
HC
The most appropriate class of medications for a patient who is hospitalized with acute decompensated heart failure, severely depressed left
cardiac output, and evidence of poor renal perfusion and who is not responding to intravenous loop diuretics is
an inotropic agent (Dobu)
The most likely diagnosis in a patient with dyspnea on exertion and deep,
symmetric T-wave inversions in leads V2 and V3 accompanied by a flat ST
segment is
unstable angina.
In a person with symptoms consistent with myocardial ischemia,
electrocardiographic (ECG) evidence of deep, symmetric T-wave inversions in
leads V2 and V3, accompanied by a flat ST segment, is suggestive of
a critical stenosis of the proximal left anterior descending coronary artery. (This ECG
pattern and associated coronary stenosis is often called Wellens syndrome.)
Most patients with
aortic dissection present with
h chest pain, and some have syncope.
The most likely diagnosis in a patient with pleuritic chest pain, fever, new scratchy
systolic and diastolic auscultatory findings, and new ST-segment elevations
within a few days after an acute myocardial infarction is
pericarditis
In-stent restenosis does not occur within days after stent placement. TRUE or FALSE?
true
When a patient with a history of stroke requires dual antiplatelet therapy, the most
appropriate medications are aspirin plus either
clopidogrel or ticagrelor. NOT prasugrel (increased bleeding risk)
Patients with pericarditis may have ST-segment elevation, but
the changes are not localized to a single coronary artery distribution.
The most likely cause of acute ST-segment elevation in a patient who recently had a stent inserted is
stent thrombosis
The most appropriate anticoagulant treatment for a patient with a non–ST-segment elevation acute coronary syndrome who is being managed noninvasively is
subcutaneous
low-molecular-weight heparin (Subcutaneous enoxaparin)
……… has technical advantages for patients undergoing early invasive management, but once a noninvasive management strategy is chosen, ………..provides a
more practical option and is associated with lower rates of recurrent myocardial infarction.
Intravenous UFH …..LMWH
……………… is usually restricted to patients undergoing early intervention and is given in the catheterization laboratory
Intravenous LMWH or fondaparinux
In addition to clopidogrel and aspirin, the recommended treatment for a patient with advanced kidney disease and evidence of a non–ST-segment elevation myocardial
infarction who does not presently have chest pain is
intravenous unfractionated heparin.
Management of new-onset atrial fibrillation that is characterized by a rapid
ventricular response despite multiple rate-control medications and a depressed
left ventricular ejection fraction should include
a trial of electrical cardioversion, if
no intracardiac thrombus is present on transesophageal echocardiography
Cardioversion in AF is indicated when
rate control is not achieved promptly with pharmacologic measures or when the
patient experiences ongoing hypotension, angina, or heart failure.
Transesophageal echocardiography to exclude intracardiac thrombus (especially
left atrial appendage thrombus) and anticoagulation are recommended when?
before cardioversion in a patient with atrial fibrillation of unknown or more than 48 hours’
duration. Anticoagulation is recommended for one month after cardioversion.
Although flecainide can be used to terminate atrial fibrillation, it should be avoided
in patients with
coronary artery disease, significant structural heart disease, or
left ventricular dysfunction.
Postcardiac injury syndrome (Dressler syndrome) should be treated with
high-dose aspirin, analgesics, and colchicine
Use of simvastatin has been associated with an increased risk for myopathy, and
several common medications increase plasma levels of this drug. Medications
that are contraindicated in simvastatin users include
ketoconazole, erythromycin,
protease inhibitors, gemfibrozil, cyclosporine, and danazol. Verapamil, diltiazem,
amiodarone, and dronedarone can be used safely only when a patient’s
simvastatin dose is kept at or below 10 mg daily. Amlodipine can be added when
the simvastatin dose is no more than 20 mg. Ramipril can be added to a
medication regimen that includes daily simvastatin at 40 mg
The most appropriate long-term treatment for a patient with chest pain and a
diagnosis of Prinzmetal variant angina is
a calcium-channel blocker.
As-needed sublingual nitroglycerin would not prevent recurrent episodes of
variant angina. TRUE OR FALSE?
true
Beta-blockers are recommended for patients with angina and conventional
obstructive coronary disease but not for patients with vasospasm and otherwise
normal coronary arteries. Propranolol (a nonselective beta-blocker) has been
shown to exacerbate
vasospasm
The medication that is most appropriate for a patient with refractory, low-level,
chronic stable angina whose heart rate and blood pressure are low-normal while
taking appropriate doses of a beta-blocker and a nitrate is
ranolazine. Ranolazine, an inhibitor of myocyte sodium channels, prevents cellular calcium
overload, reduces diastolic wall tension, and improves oxygen supply–demand
mismatch — thereby improving angina. Ranolazine has minimal effects on blood
pressure and heart rate. In a patient with chronic stable angina who is receiving
maximal doses of routine antianginal medications or whose low blood pressure
and heart rate prevent the safe uptitration of other antianginal agents, ranolazine
is the therapy of choice
……….is an absolute contraindication to
thrombolytic therapy because of concern for hemorrhagic conversion and
intracranial hemorrhage in this setting. Hence, this patient should not receive
reteplase, tenecteplase, or alteplase.
An ischemic stroke within the past 3 months
Other absolute contraindications to
thrombolytic therapy include previous intracranial hemorrhage, cerebrovascular
lesion or intracranial neoplasm, suspected aortic dissection, active bleeding or
diatheses, closed-head or facial trauma within the past 3 months, intracranial or
intraspinal surgery within the past 2 months, and severe uncontrolled
hypertension that is unresponsive to emergency treatment.
The goal is to perform primary PCI within ………. after the first
medical contact.
90 minutes
The lipid-lowering therapy that is most appropriate for a patient with an acute coronary syndrome is
high-dose statin therapy, such as atorvastatin 80 mg daily
Patients ……………..who are experiencing a myocardial infarction are
more likely than other patients to present without chest pain. Health care
providers should be alert for atypical symptoms such as jaw, neck, ear, arm, or
epigastric discomfort, which can be “anginal equivalents.” New-onset exertional
dyspnea is the most common anginal equivalent.
with diabetes mellitus
Cardiogenic shock, which occurs in about ………….f patients with acute
myocardial infarction (AMI), is associated with high rates of morbidity and
mortality.
5% to 8% o
Mechanical causes of post-AMI cardiogenic shock are
pump failure,
acute mitral regurgitation (MR) caused by papillary muscle rupture, ventricular
septal rupture, and free wall rupture. A papillary muscle rupture is the mechanical
complication most likely to cause cardiogenic shock in a patient who has had an
inferior myocardial infarction and has no evidence of intracardiac shunting.
A 72-year-old woman presents with an 8-month history of chest pressure and left-arm pain that occur only during substantial physical activity. Nuclear imaging during an
exercise test identifies a reversible area of hypoperfusion in the distribution of the right coronary artery. Other than optimizing medical therapy, what is the most appropriate
management approach?
Patients with low-risk stable angina are best managed with optimal medical therapy and do not require further investigation.
Dobutamine echocardiography, a form of pharmacologic stress testing with echocardiographic imaging during rest and stress, is indicated in a patient
who cannot exercise.
Echocardiography is preferred over nuclear imaging when
dyspnea prompts the stress testing, because the patient’s diastolic left ventricular function, valvular abnormalities, and right ventricular function and pressures can be assessed.
Coronary CT angiography is reasonable for symptomatic patients who
are at intermediate risk for CAD, including patients with equivocal stress-test results and those with
known or suspected coronary anomalies.