41 - Post-MI

Question 1

DAPT x how long?

Answer 1

1 year

Question 2

Non-pharms

Answer 2

• weight management
• target waist circumference < 100 cm in males and < 90 cm in females
• sustain 5-10% weight loss
• regular exercise
• ICD is indicated in select patients with significant residual LV dysfunction despite aggressive medical therapies for 3 or more months

Question 3

After MI, what are patients at risk for?

Answer 3

MACE (major adverse CV events)

• nonfatal MI
• death
• stroke

Question 4

Secondary prevention with several classes of drugs independently reduces incidence of MACE by ___%

Answer 4

25

Question 5

Antiplatelet therapy:

current guidelines say to use what?

Answer 5

prasugrel or ticagrelor as 1st line after NSTEMI or STEMI but they have increased bleeding rates compared to clopidogrel

Question 6

Ticagrelor can cause ______

Answer 6

dyspnea (14%)

Question 7

Antiplatelet therapy consists of ?

Answer 7

ASA + P2Y12 inhibitor

Question 8

When should beta blockers be started ?

Answer 8

within a few days of infarction

Question 9

BB should be continued indefinitely but can be stopped in what situations?

Answer 9

if patients have normal LV function or if fatigue or other s/e are affecting QOL

Question 10

ACEi considered for all patients post-MI especially if they have what other medical conditions?

Answer 10

LVEF < 40%, HTN or DM

Question 11

How do ACEi’s help post-MI?

Answer 11

play a role in LV remodelling post-MI

they decrease CV death and MI

Question 12

Who should ACEi be avoided in?

Answer 12

pregnant patients, renal dysfunction or hyperkalemia

Question 13

____ as alternative to ACEi

Answer 13

ARB

Question 14

Consider MRA (ex. spironolactone, eplerenone) in which patients?

Answer 14

those with significant LV dysfunction

Question 15

Use ___-dose statins early after MI

Answer 15

high

Question 16

What is your target for statins?

Answer 16

LDL < 2 mmol/L or 50% decrease from baseline

Question 17

Which alternative cholesterol lowering agents can be used?

Answer 17

• ezetimibe - also helps with CV risk

- niacin

Question 18

Use oral anticoagulants for which patients?

Answer 18

post-MI with a. fib

Question 19

Warfarin + DAPT increases bleed risk so which P2Y12 inhibitor should you use?

Answer 19

clopidogrel bc it has least risk of bleed compared to others in it’s class

Question 20

If thrombus dissolved in 3 months, what do you do?

Answer 20

consider d/c anticoagulant

Question 21

What other anticoagulants may have less bleed risk compared to warfarin?

Answer 21

• dabigatran

- rivaroxaban

Question 22

Avoid which diabetic medication post-MI

Answer 22

TZDs

Question 23

Which NSAID is the safest for CV risk?

Answer 23

naproxen