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Flashcards in CAD Screening Deck (14):
1

What are the four USPSTF criteria for when screening is valuable?

  • Disease:
    • Is common and serious
    • Has a prolonged asymptomatic phase
  • Test:
    • Has few false-positives
    • Leads to an improvement in health outcomes

2

What are the characteristics of a screening test which provide value?

  • low false-positive rate
  • use must lead to improved clinical outcomes

3

What is an Impella? 

What are the effects?

  • Continuous axial flow device that pumps blood from the LV into the ascending aorta
  • Effects:
    • unloads the LV
    • increases CO
    • reduces myocardial O2 demand

4

Describe the different types of Impella?

  • Impella 2.5
    • 12 Fr device implanted percutaneously
    • provides a maximal flow of 2.5 L/min
  • Impella CP
    • 14-Fr device implanted percutaneously
    • provides a maximal flow of 3-4 L/min
  • Impella 5.0
    • 21-Fr device that requires surgical cut-down
    • provides maximal flow of 5 L/min

5

What are the two criteria that must be fulfilled to obtain CMS coverage of a VAD used as a BTT?

  • Patient is approved and listed as a candidate for heart transplantation by a Medicare-approved heart transplant center
  • Implanting site, if different than the Medicare-approved transplant center, must receive written permission from the Medicare-approved heart transplant center under which the patient is listed prior to implantation of the LVAD

6

 What are the two criteria that must be fulfilled to obtain CMS coverage of a VAD used as a DT?

  • NYHA functional class IV symptoms in patients ineligible for heart transplantation
  • Failure to respond to OMT for at least 45 of the last 60 days or 
  • Balloon pump-dependent for 7 days
  • IV inotrope-dependent for 14 days
  • LVEF < 25%
  • Functional limitation with a peak oxygen consupmtion < 14 ml/kg/min

7

What is the appropriate patient to perform CCTA in?

Why is this test good for this patient population?

  • Symptomatic patients
  • Low-intermediate pre-test probability (risk)
  • high sensitivity and negative predictive value

8

What is the goal of high-intensity statin therapy?

LDL-C reduction of at least 50%

9

Define ACS

  • a collection of clinical conditions that include acute myocardial ischemia and/or myocardial infarction
  • secondary to an abrupt reduction in coronary blood flow or a mismatch in myocardial oxygen supply and demand

10

What are the types of ACS?

  • STEMI
  • NSTEMI
  • UA

11

What is the pathophysiology of plaque rupture in ACS?

  • acute disruption (or "rupture") of a form of plaque that is biologically quite distinct form the more benign stable plaque
  • Vulnerable plaque = thin-capped fibroatheroma (TCFA)
    • thought to be the culprit in most forms of ACS

12

What did the PLATO trial show?

In NSTEM-ACS, Ticagrelor was assocaited with less CV mortality than Clopidogrel

13

What EKG finding in RV MI / IMI is associated with higher mortality rate?

ST-elevation in V4R

14