CAD Flashcards
When to order a 15 lead ECG?
Inferior MI
ST elevations in II, III aVF
What is the TIMI risk score?
Risk stratification for unstable angina and NSTEMI
1pt each for age>65 >3 CAD risk factors prior stenosis >50% ST changes 2+ anginal events <24h ASA in last 7 days positive troponin
Max TIMI score? Risk score categories?
Max = 7
0-2 = low risk 3-4 = medium risk 5-7 = high risk
How is TIMI score used?
low risk = meds
medium = meds + consider revascularization
high = PCI or CABG
Advantages of PCI?
More effective than pharmacotherapy for relief of angina
Less invasive, shorter hospital stay and less incidence of stroke than CABG
Advantages of CABG?
More effective than pharmacotherapy and PCI for angina relief
More complete revascularization than PCI
Improved survival in certain patients
Which patients would benefit from improved survival with CABG over PCI?
> 50% L main A stenosis
3 vessel CAD w/ LV dysfunction
2 vessel CAD w/ proximal LAD stenosis esp. if LV dysfunction
diabetes + multivessel disease
Modifiable risk factors for CAD?
Obesity HTN Diabetes Dyslipidemia Smoking
Non-modifiable risk factors for CAD?
Age
Male gender
Family history
Management goals of angina?
Decrease freq + sev of angina
Prevent cardiac events
Prolong survival
Address risk factors
Drugs that treat/prevent angina?
Nitrates
Beta blockers
CCBs
Drugs that decrease cardiac events/prolong survival?
ASA + clopidogrel + heparin Beta blocker Statins ACEi Diuretic if patient has heart failure
Indications for revascularization?
Angina refractory to meds High risk post-stress test Side effects to meds LV dysfunction with typical angina Pts who can't be stress tested
Ways of stressing the heart?
Exercise (Bruce, modified Bruce)
Adenosine, dipyridamole, dobutamine
Ways of assessing how the heart responds to stress?
ECG
Radionuclide myocardial perfusion imaging (sestamibi)
ECHO
