6. Ischemic Heart Disease

Question 1

prevalence of ischemic heart disease

Answer 1

30% of periop pts

Question 2

ischemic heart disease risk factors

Answer 2

genetic
high fat diet
male
smoking
elderly
obesity
diabetes
HTN
sedentary
hypercholesterolemia

Question 3

ischemia balances

Answer 3

O2 delivery and O2 consumption

Question 4

angina diagnosis

Answer 4

retrosternal chest discomfort
crescendo-decrescendo pain over several minutes

Question 5

angina dermatomes

Answer 5

C8-T4

Question 6

chest wall movement pain indicates

Answer 6

costochondritis

Question 7

stable angina

Answer 7

chest pain that doesnt change over 2+ months

Question 8

stable angina pathophys

Answer 8

mild partial occlusion
atherosclerosis

Question 9

most common cause of stable angina

Answer 9

atherosclerosis

Question 10

stable angina diagnosis

Answer 10

stress test
EKG may be normal

Question 11

chemical stress test

Answer 11

atropine
dobutamine
cardiac pacing
adenosine

Question 12

coronary steal drugs

Answer 12

adenosie
dipyridamole

Question 13

gold standard for angina diagnosis

Answer 13

coronary angiography

Question 14

catheter placement in coronary antiography

Answer 14

femoral artery

Question 15

acute coronary suyndrome

Answer 15

worsening O2 demand/supply imbalance

Question 16

most common reason for ACS

Answer 16

focal disruption of atheromatous plaque

Question 17

STEMI pathoploy

Answer 17

CRP and fibrinogen increased

Question 18

STEMI diagnosis

Answer 18

EKG changes
troponin level

Question 19

troponins elevate within

Answer 19

3 hrs of MI

Question 20

troponin 1

Answer 20

> 40 ng/L

Question 21

troponin T

Answer 21

men: > 22 ng/mL
women: > 14 ng/mL

Question 22

when do you not need an echo for MI

Answer 22

if you have EKG evidence

Question 23

STEMi treatment

Answer 23

beta blockers
referfusion (30 mins/12 hrs)
PCI (90 mins/12 hrs)

Question 24

chronic NSETMI treatment

Answer 24

stabilize w/statins

Question 25

acute NSTEMI treatment

Answer 25

betal blockers antithombotics supp O2

Question 26

drug eluting stent reduces

Answer 26

neointimal hyperplasia

Question 27

issues with stents

Answer 27

thrombosis bleeding

Question 28

how long does it take to reendothelialize

Answer 28

2-3 weeks

Question 29

bare metal reendothelialise

Answer 29

12 weeks

Question 30

drug eluting stent reendothelialize

Answer 30

up to 1 year

Question 31

DAT

Answer 31

aspirin + P2Y12 inhibitor (plavix)

Question 32

without stent wait for surgery

Answer 32

2-4 weeks

Question 33

BMS wait for surgery

Answer 33

30 days-12 weeks

Question 34

CABG wait for surgery

Answer 34

6 -12 weeks

Question 35

DES wait for surgery

Answer 35

6-12 months

Question 36

MAC risk 4 weeks post PCI

Answer 36

10%

Question 37

MACE risk 90 days post PCI

Answer 37

4%

Question 38

MACE risk > 90 days post PCI

Answer 38

3%

Question 39

apiring increase bleading risk

Answer 39

1.5times

Question 40

plavix + aspirin increases bleeding risk

Answer 40

2.25x

Question 41

stop clopidogrel/ticagrelor

Answer 41

5 days

Question 42

stop prasugrel

Answer 42

7 days

Question 43

surgeries you must stop antiplt therapy

Answer 43

neuro aorti aneurysm prostatectomy (high bleeding risk)

Question 44

continue DAPT after angioplasty

Answer 44

2 weeks

Question 45

continue DAPT after BMS

Answer 45

6 weeks

Question 46

continue DAPT after DES

Answer 46

12 months

Question 47

when can you give plts after last clopidogrel dose

Answer 47

4 hrs

Question 48

when is plt transfusion most effective

Answer 48

24 hours after clopidogrel dose

Question 49

predictors of major cardiac complications

Answer 49

high risk surgery MI CHF stroke/TIA IDDM Cr>2.0mg/dl

Question 50

wait _____ days after MI for surgery

Answer 50

60+ days

Question 51

which is better TIVA or VA

Answer 51

no difference

Question 52

when do you treat ST segment change

Answer 52

> 1mm

Question 53

normal/elevated BP

Answer 53

give NTG

Question 54

HR elevated normal/high BP

Answer 54

give esmolol