Ischemic Heart Disease

Question 1

Drugs used for Pharmacologic Stress Test

Answer 1

Dobutamine
Adenosine
Dipyridamole

Question 2

Target LDL level for patients with CAD

Answer 2

<100mg/dL

Question 3

Target LDL level for patients with DM

Answer 3

<70mg/dL

Question 4

First line drugs for Chronic Coronary Syndrome

Answer 4

Beta Blockers and/or CCB

Question 5

Risk Factors for IHD

Answer 5

Male > 45, Female > 55, HTN, DM, Dyslipidemia, Obesity, Smoking, Physical Inactivity, Family History of Premature CAD

Question 6

Anginal Equivalents

Answer 6

Dyspnea, Fatigue, Faintness especially in elderly, women, diabetic

Question 7

Canadian CVS Society Functional Classification of Angina

Answer 7

I - no limitation
II - slight limitation
III - marked limitation
IV - Inability to carry on any physical activity without discomfort

Question 8

Patient experiences angina after walking two blocks on the level or after climbing more than one flight of stairs in normal condition. What functional classification?

Answer 8

FUNCTIONAL CLASS III

Question 9

Second Line Anti-Anginal Drugs

Answer 9

Nitrates
Ivabradine
Nicorandil
Trimetazidine
Ranolazil

Question 10

When to send a patient with coronary angiogram?

Answer 10

1. Stress Test negative or nondiagnostic with persisting angina
2. Patients whose career involves safety of other with questionable symptoms
3. AS or HCM with angina
4. For Cardiac operation + Age
5. After MI
6. High Risk
7. Nonatherosclerotic cause of MI
8. Maximal therapy not effective
9. EF<40% IHD not ruled out

Question 11

Blood flow reduced at

Answer 11

50% stenosis

Question 12

Blood flow limited at

Answer 12

80% stenosis

Question 13

Drugs for Event Prevention in IHD

Answer 13

C. A. S. A.
Clopidogrel
Aspirin
Statins
ACEi/ARBs

Question 14

Indications for CABG

Answer 14

Left Main Coronary Artert
3 vessel disease + LVEF<50% OR DM
2 vessel disease that includes Left Descending Coronary Artery

Question 15

MI Classification

Answer 15

1 Spontaneous
2 Secondary to Ischemia
3 Biomarkers unavailable
4a PCI related
4b Stent Thrombosis related
5 CABG related

Question 16

ECG findings in STE-ACS

Answer 16

ST Elevation >=2mm on V1-V6 or >=1mm in limb leads

Question 17

ECG Findings in NSTE-ACS

Answer 17

ST Depression >=1mm in any leads or T Wave inversion of at least 5mm

Question 18

LAD supplies leads?

Answer 18

V1, V2, V3, V4

Question 19

LCX supplies leads?

Answer 19

V5-V6, Inferior II, III, AVF (10%), High Lateral I, AVL

Question 20

Biomarker best for detecting re infarction?

Answer 20

CKMB

Question 21

TROPONINS can be detected for up to how many days?

Answer 21

Elevated up to 7-10 days

Question 22

CKMB can be detected up to how many days?

Answer 22

1 - 2 days

Question 23

Management for STE-ACS

Answer 23

Urgent revascularization via Thrombolysis and PCI

Question 24

Management for NSTE-ACS

Answer 24

Primarily medical

Question 25

High risk factors that warrant invasive management for NSTE-ACS

Answer 25

``` Refractory chest pain Persistent ST Deviation Ventricular Tachycardia Hemodynamic Instability Signs of Heart Failure ```

Question 26

In NSTE-ACS, chest pain is severe and has one of the following (3):

Answer 26

``` crescendo pattern recent onset (<2 weeks) occurring at rest or minimal exertion, lasting >10mins. ```

Question 27

TIMI Scoring for NSTE-ACS

Answer 27

``` K. A. C. A. S. E. S. (1 point each) Known CAD Aspirin use within 7 days CAD Risk Factors >=3 Age >=65 Severe Angina in last 24 hours Elevated biomarkers ST Deviation >0.5mm ``` High Risk if >=3 points

Question 28

First cardiac marker to rise in ACS

Answer 28

Myoglobin

Question 29

KILLIP Scoring for STEMI

Answer 29

I - normal BP, no congestion II - moderate HF, bibasal rales, normal BP III - Severe HF, midbasal rales, S3&S4, normal BP IV - shock with SBP < 90, peripheral vasoconstriction, cyanosis

Question 30

Temporal Stages of STEMI

Answer 30

Acute - <7 days Healing - 7 to 28 days Healed - >=29 days

Question 31

STEMI patient initially seen at PCI-capable hospital. FMC-DEVICE TIME?

Answer 31

<=90 mins.

Question 32

STEMI Patient initially seen at non-PCI capable hospital. FMC-DEVICE TIME?

Answer 32

<=120 mins.

Question 33

Clear Contraindications to Thrombolysis in STEMI

Answer 33

A B C H H ``` Aortic Dissection (Suspected) Bleeding (Active Internal) Cerebrovascular Hemorrhage at any time Hypertension (>180 SBP >110 DBP) non - Hemorrhagic stroke within last year ```

Question 34

Most common cause of out of hospital death from STEMI

Answer 34

Ventricular Fibrillation

Question 35

Most common cause of in hospital death from STEMI

Answer 35

Pump Failure

Question 36

Most common cause of death within 24 hours of admission

Answer 36

Re - M.I.

Question 37

If a patient with acute MI presents with new murmur, think of 2 potential conditions:

Answer 37

free septal wall rupture | acute mitral regurgitation

Question 38

Ventricular Fibrillation/ Pulseless VTach What will you do?!

Answer 38

SCREAM Shock - defibrillate (monophasic - 360j, biphasic - 200j) CPR Epinephrine - 1mg every 3-5 minutes Amiodarone - 300mg IV bolus then 150mg

Question 39

68/M came in for sudden onset of substernal chest pain. ECG revealed inferior wall STEMI without Right Ventricle involvement. Which medications are contraindicated?

Answer 39

Inferior wall STEMI without RV involvement - Beta Blockers Inferior wall STEMI with RV involvement - Beta Blockers and Nitrates