Cardiology (10-20%) Complete Flashcards
(84 cards)
Principles of Non-Invasive Testing for
stable CAD
Absolute Contraindications to EST (Exercise Stress Test)
EST Results (Exercise Stress Test)
• Maximal vs. submaximal test
– Patient should reach ______% of age-predicted maximum heart rate
– (Max HR = ____________)
EST Results (Exercise Stress Test)
• Maximal vs. submaximal test
– Patient should reach 85% of age-predicted maximum heart rate
– (Max HR = 220 – age)
EST (Exercise Stress Test) Results:
Positive test:
________________
________________
High-risk features?
Myocardial Perfusion Imaging
Coronary CT Angiography (CCTA)
Treatment of Chronic Stable CAD
• Treat symptoms with ____________ first
• Consider _________ if refractory symptoms, high-risk structural disease (e.g. LM disease), LV dysfunction, severe MR
Optimal Medical Therapy (OMT) is ________ to revascularization (PCI/CABG) for patients with Stable CAD
ISCHEMIA TRIAL:
The bottom line is all-cause mortality was ________ by an invasive strategy.
• Treat symptoms with medical therapy first
• Consider revascularization if refractory symptoms, high-risk structural disease (e.g. LM disease), LV dysfunction, severe MR
Optimal Medical Therapy (OMT) is non-inferior to revascularization (PCI/CABG) for patients with Stable CAD
ISCHEMIA TRIAL:
The bottom line is that all-cause mortality was not reduced by an invasive strategy.
Treatment of Chronic Stable CAD
ALL patients with CAD:
– Commence __________ for CAD
– __________ + __________ for evidence of coronary atherosclerosis regardless of the modality of diagnosis
– __________ can be used as __________ if __________ intolerant
Treatment of Chronic Stable CAD
ALL patients with CAD:
– Commence medical treatment for CAD
– Aspirin + statin for evidence of coronary atherosclerosis regardless of the modality of diagnosis
– Plavix can be used as SAPT if ASA intolerant
Treatment of Chronic Stable CAD
Antianginal ( ____________ benefit)?
Disease-modifying therapies?
Adjunctive therapies?
Treatment of Chronic Stable CAD
Revascularization - PCI vs. CABG
Acute Coronary Syndromes:
Immediate Medical Management
Reperfusion Therapy – STEMI
• Primary PCI > fibrinolysis:
– ___________
• PCI capable hospital -> FMC-to-balloon
time < ____ min
• Non-PCI capable hospital -> FMC-to-
balloon time < ____ min
– if later presentation (______h of symptom onset)
– if ________ shock
• Fibrinolysis indicated if _________ ( ___ mins)
• __________ strategy superior to rescue PCI: Drip (give lysis) then ship (send immediately to PCI center for angiogram/PCI within ____ hours)
– If fibrinolysis -> should be administered
within ___ minutes of FMC
– If Fibrinolysis -> PCI should occur within
___ hours
– Timing of fibrinolysis -> the earlier, the
better, but can be given up to ____h after
onset of chest pain w STE
Contraindications to thrombolysis
for STEMI?
The Second Antiplatelet:
• ________/_______ are more potent than _______, with ______ efficacy but more ______ risk
• Ticagrelor is contraindicated if there is a history of: __________, __________, __________, __________
– Should consider avoiding in patients with
evidence of __________ or __________
• Prasugrel is contraindicated if __________, __________ or __________ while on prasugrel, __________ reaction
– If elective PCI, only __________ has been studied
– If a patient has AFIB on OAC, _________ is recommended [CCS AFib 2020]
• __________ have NOT been adequately evaluated in the setting of fibrinolysis in STEMI -> Use __________ only
Reperfusion Therapy - NSTE-ACS
Int/high-risk patients:
- _________ strategy (angiogram within ____hr) and it reduces the risk of _________ but NO _________
PCI
• Bare metal stent (BMS) – rarely used
– Endothelialize quickly = ______ risk of stent thrombosis after 4+ weeks
– But…higher risk of ______
• Drug-eluting stent (DES) – standard of care
– Elute anti-proliferative agents
– Lower rates of ______ vs. BMS = can be used in smaller vessels, CABG grafts
– But…take longer to endothelialize
• Drug-coated balloon (DCB)
– Expand a blood vessel and deliver antiproliferative agents (e.g. Paclitaxel) without delivering a stent
– Useful for ______, ______, ______
Stents and DAPT Durations (without AF)
POST ACS (STEMI or NSTEMI/UA): Aim for ______ months of DAPT
– ACS DAPT= _____ + _____ (dose) or _______ (dose) (preferred over ____ + _____)
• Reassess bleeding at _______ (time)
– If HIGH-RISK bleed: ________
– If LOW-RISK bleed: ________ - Good evidence for up to _______ years (DAPT trial)
DAPT After 12 months: Suggest ____ + one of:
• _________ (dose)
• _________ (dose)
Stents and DAPT Durations (without AF)
Non-ACS situations (ELECTIVE PCI)
• High Risk of Bleeding: Elective PCI DAPT = ________ + ________
– BMS = DAPT for ____ months then ____
with ____ or ____ indefinitely
– DES = DAPT for ____ months then ____
with ____ or ____ indefinitely
• Not at high risk of bleeding: DAPT for ________ months, then reassess
– If High-Risk thrombotic events: extend
DAPT up to ______ yrs
– If not at high risk of thrombosis or if now
at high-risk bleeding: _______
Periop Mgmt - Stents and DAPT
Elective Non-Cardiac Surgery
• BMS – Delay surgery for at least _____ months
post-PCI
• DES – Delay surgery for at least _____ months
post-PCI
Semi-Urgent Non-Cardiac Surgery
• BMS – Delay surgery for at least _____ months
post-PCI
• DES – Delay surgery for at least _____ months
post-PCI
Post-MI Complications
• Arrhythmias
– Brady: Heart block (esp. _______ MI)
• Mechanical complications
– RV infarction (esp. _______ MI)
• Pericarditis
– Post MI pericarditis = Early (___d) vs. delayed [_____ syndrome] (_____ wks)
– Rx is ______ + ______
ACS: Chronic Management/Risk factors
Initiate BEFORE Discharge
• __________________
• __________________
• ________ vaccine administered within 72 hours post-STEMI/NSTEMI reduced all-cause mortality, MI, and stent thrombosis at 12 months compared to placebo
Driving Restrictions - CAD
STEMI:
Private Car: ______ months post-discharge, Commercial Driver (Truck, Bus) ______ months post-discharge
NSTEMI with wall motion abnormalities
Private Car: ______ months post-discharge, Commercial Driver (Truck, Bus) ______ months post-discharge
UA or NSTEMI with no LV damage
With PCI: Private Car: ______ post-discharge, Commercial Driver (Truck, Bus) ______ post-discharge
Without PCI: Private Car: ______ post-discharge, Commercial Driver (Truck, Bus) ______ post-discharge
CABG: Private Car: ______ months post-discharge, Commercial Driver (Truck, Bus) ______ months post-discharge
Elective PCI: Private Car: ______ post-discharge, Commercial Driver (Truck, Bus) ______ post-discharge
Hypertrophic Cardiomyopathy
• Broad management principles:
– Family screening/genetics for ________
– Avoid ______/______
– ______: chest pain syndromes, LVOT Obstruction, SAM
• Second line – ______, ______
– Interventions for some – ______/______
– ______ for ANYONE with AF (______ does not apply)
– Consideration for ICD if:
• Sustained ______ or prior ______ (Class I)
• FMHx of ______, LV wall thickness >______ mm, ______ syncope (Class IIa)
• NSVT or abN BP response on treadmill w/ other risk factors (Class IIa)
HCM. What happens to murmur with these?
Bradycardia?
A Passive leg raise?
Handgrip?
Valsalva?
Standing up?
ACEI?
• Treatment involves?
• Avoid?
