deck 1 Flashcards
(46 cards)
Which score can be used in low-risk settings to predict CVD risk (in lieu of Framingham score)?
the Harvard NHANES score above score utilizes traditional risk factors (age, sex, smoking, SBP) but exchanges cholesterol for BMI this predictive value of this score is as good as for Framingham risk score
Does treatment of HTN affect prognosis of diastolic HF?
yes it reduces the incidence of: 1. acute pulmonary edema 2. ADHF no studies have shown any improvement in mortality, however
According to expert consensus on CT coronary calcium scoring, which patients are appropriate for this study?
appropriate patient populations for CT calcium scores have either of the following: 1. intermediate pretest probability 2. low pretest probability but (+) family history
Patient with dypsnea undergoes cardiac catheterization and the simultaneous RV & LV pressure tracings are recorded (shown below). What is the diagnosis?
dx = constrictive pericarditis
hemodynamic dx of constriction:
- equalization of ventricular filling pressures
- ventricular interdependence during systole (RVSP increases at the expense of LVSP during inspiration)
Pt with chest discomfort has the following CT chest:
What to do next? (2 things)
- this is type I dissection (involves both ascending & descending aorta)
- therefore next steps are:
- receive medical therapy to reduce shear forces (antihypertensives)
- referral for immediate surgery
85M patient is scheduled for angiogram. He has CKD and Cr =2.5 today (his baseline). What to do prior to cath?
- give IV NS 1-3 hour before and up to 6 hours after cath
- above strategy increases urine output and may protect against contrast-induced nephropathy
A patient with buttock claudication during ambulation has the following exercise ABI values:
What to do next??
- exercise ABI is less than 0.7 in both legs, which is consistent w/ moderate PVD
- –> give these patients:
- supervised exercise program
- cilastazol
A 44F is a/w acute MI to the CCU. The bed next to her is occupied with a 48M who also was a/w MI. Both patients were revascularized.
Which one has a higher mortality risk?
The female has a higher mortality risk
females under age 50 have higher mortality a/w acute MI compared to males
A young male who is s/p MI 2 weeks ago wants to know if he needs to continue to take his metoprolol. What to tell him?
Taking a beta blocker in subacute period post-MI will decrease incidence of death related to VT/VF the above was first shown in the BHAT (beta blocker heart attack trial), 1982
What is relative wall thickness and how do you calculate it?
RWT estimates ratio of LV cavity size to LV wall thickness at end diastole -> allows to determine if LVH is eccentric or concentric RWT = 2*PWd/LVEDD Where PWd = post wall thickness @ end diastole LVEDD = LV end diastole dimension
How is LV mass index calculated using echo and what is its significance?
LV mass is calculated by obtaining IVS dimension, LV dimension, and PW dimension, all at end diastole. LV mass index (LVI) is obtained by referencing pt’s body surface area LVI > 85 -> LVH in women LVI > 115 -> LVH in men
Which 3 studies are often cited as class I evidence for implantation of ICD as secondary prevention of sudden cardiac death?
AVID
CIDS
CASH
Sgarbossa criteria (3)
- Used to diagnose MI in setting of LBBB
- 2 points: ST change > 5 mm DISCORDANT with qrs complex
- 3 points: ST depression > 1 mm in V1-V3
- 5 points: ST change > 1 mm CONCORDANT with qrs complex
- 3+ points -> 90% specificity for MI
Which was the first trial to show mortality benefit with thrombolytics post-STEMI?
- GISSI
- Benefit only present when given within 6 hrs of onset of chest pain
Pt with MAP of 43, cardiac output = 6.4, IVC is < 2.1 cm & collapsing on echocardiogram. What is the estimated SVR? Which type of shock is this?
SVR = 80*(MAP - RAP)/CO -> SVR = 500 normal SVR = 1000-1500 (roughly);
thus this is distributive shock
A young pt in the CCU is hypoxic and short of breath. You place a swann-ganz catheter to help determine hemodynamic status. You obtain the following values: PAP = 58/38, wedge pressure = 13, CO = 4.2. What is the most likely etiology of this patient’s dyspnea? (2 possible diagnoses)
- calculate PVR to help determine if dyspnea is due to left heart failure, intrinsic pulmonary disease, or both
- PVR = (MPAP - wedge)/CO where MPAP = mean pulmonary arterial pressure = 2/3*38 + 1/3*58 = 46 -> PVR = ~8
- (normal PVR is less than 4 wood) -> pt likely has primary pHTN or PE
2 situations in which you should consider using IVUS technology during cath?
- assist in guiding angioplasty (especially in Lt main & LAD lesions)
- check how well prior stent has been deployed within coronary artery (rule out underexpansion)
Pt with exertional chest pain is found to have a flow-limiting lesion in the left main artery. IVUS is performed revealing minimal luminal area (MLA) of 5.5. What to do next?
- place a stent in the left main artery
- left main artery MLA < 6 on IVUS is an indication for stenting, regardless of whether or not symptoms are present (improves 1 year mortality)
Pt with chest pain is found with minimum luminal area in proximal LAD = 4.2 cm2. Angiography estimates the lesion as 35% occlusion. What to do next?
- do NOT stent the artery IVUS indications for stenting in pt with LAD dz (either of the following):
- MLA < 4.0 cm2 + symptomatic
- MLA < 3.0 cm2 and no symptoms
Pt p/w exertional CP, found with TnT 2.8, CK 305, CK-MB 30. EKG with ST depressions in inferior leads. He is placed on heparin gtt & dual antiplatelet load but continues to have chest pain. What should you do next? (name 3 trials that help guide your management)
send for PCI
NSTEMI with continued chest pain despite optimal medical therapy -> send for cardiac cath (TIMI-18, TACTICS, FRISC II)
TIMI flow scheme for cath (4)
TIMI 0: complete obstruction TIMI 1: (+) flow beyond obstruction with incomplete filling TIMI 2: (+) flow and (+) complete filling, sluggish TIMI 3: normal filling
Name 4 “triggers” of acute MI.
- Sexual activity
- Earthquakes
- Anger
- Generalized stress
You are preparing to give tPA to a pt with acute STEMI. You order aspirin 325 for the pt. The intern asks you why you are giving aspirin in addition to the thrombolytic. What do you tell him & which trial should you cite?
- With regard to acute STEMI: mortality benefit of asa & tPA are similar as monotherapy, additive when given together
- The trial is ISIS-2
Pt has h/o ICM (EF 38%) a/w several runs of NSVT. He had a heart attack 2 months ago. o/e he is NOT in heart failure. What to do next?
- Take for EPS study to see if VT is inducible.
- If VT is inducible, then pt should receive ICD
- GLs: EF < 40%, (+) NSVT, 40+ days post-MI -> send for EPS study +/- ICD (MUSTT trial)
- *note that you do not have to be in heart failure to meet criteria for EPS based on MUSST trial
