Cardiology

Question 1

T/F: Cilostazol improves PAD outcomes and should be started if confirmed on imaging

Answer 1

False, does not improve outcomes. Should be used for intermittent claudication symptoms (PDE inhibitor)

Question 2

stress test of choice when normal baseline EKG and intermediate prob of obstructive cad

Answer 2

Exercise stress test (exercise EKG)

Question 3

when is repair indicated for AAA?

Answer 3

Any:

• size > 5.5cm
• rapid expansion (>0.5cm/year)
• symptoms (abdominal pain)

Question 4

minimum DAPT duration after drug-eluting stent vs bare metal stent. Stable angina vs ACS

Answer 4

Stable angina:
DES: 6 months
Bare metal: 1 month

Any PCI after ACS: DAPT for at least 12 months. Extending for some can have benefits (i.e. 30 months)

Aspirin indefinitely unless contraindicated

Question 5

initial treatment for descending aortic dissection (type B)

Answer 5

Medical therapy: beta-blocker, sodium nitroprusside, opioids

Question 6

T/F: Oral anticoagulation without antiplatelet (i.e. aspirin) in patient with Afib and CAD is sufficient for prevention of both ACS and thromboembolism

Answer 6

True, you can stop aspirin if CAD patient develops afib

Question 7

when would you use a treadmill stress test other than ischemic evaluation?

Answer 7

To evaluate for chronotropy (HR response to exercise), i.e. sx bradycardia

Question 8

what #s signify significant LV dilation?

Answer 8

end-systolic dimension > 50mm, indexed end-systolic dimension >25mm/m2

Question 9

which patients with NSTEMI should have urgent angiography?

Answer 9

moderate (3-4) or high (5-7) TIMI scores. 
\+1 Age>65
\+1 >3 CAD risk factors (htn, high cholesterol, DM, fhx CAD, current smoker)
\+1 known CAD (>50%)
\+1 ASA past 7 days 
\+1 severe angina (2 ep/24 hrs)
\+1 EKG ST changes > .5mm
\+1 positive cardiac marker

Question 10

how do you stress test a patient with LBBB?

Answer 10

need stress with additional imaging, i.e. nuclear perfusion imaging or stress echo (i.e. Adenosine single-photon emission CT). Cannot use exercise or dobutamine stress because can have FP defect in basilar septum…do vasodilator (dipyridamole, regadenoson, adenosine)

Question 11

how will a periaortic abscess from IE present on ekg?

Answer 11

first degree AV block, or prolongation of PR interval (interfering with conduction system)

Question 12

at what gestational age is pregnant patient still have new dx of chronic hypertension and which agents?

Answer 12

any diagnosed before 20th week. Labetalol and methyldopa = agents of choice pregnant hypertension

Question 13

Which HF patients would you recommend CRT when ICD is indicated?

Answer 13

Look for LBBB with a QRS >150

Question 14

increased risk of cardiovascular events in patients with diabetes

Answer 14

2-4x increased risk cardiovascular dz; 2/3 of patients dye of heart disease; 1.8-6x increased risk for stroke

Question 15

statin in patient with diabetes

Answer 15

All DM patients 40-75 should have moderate intensity statin. If 10-year ASCVD 20% or higher, do high intensity.

Question 16

Antiplatelet therapy after ACS (includes NSTEMI)

Answer 16

Aspirin indefinitely
DAPT with P2y12 inhibitor (Ticagrelor > Clopidogrel) for at least 12 months. Prasugrel is an option reserved for patients with PCI

Question 17

T/F: CABG is the superior revascularization strategy in patients with multivessel CAD + diabetes

Answer 17

True