Step 2 Flashcards
(58 cards)
pretest probability of CAD is intermediate ?next step
if able to exercise then exercise stress test
if not then pharmacological stress test with Dobutamine echo or dipyramidole thallium
if either are positive then next step is coronary angio
treatment for prinzmetal (vairant) angine
caused by vasospasm of coronary arteries
often occurs in young smokers
1st line: dipyridamole CCBs +/- long acting nitrates
aspirin and betablockers can worsen symptoms
at what Sa02 would you give supplemental 02 in MI
<90% OR if breathless
what is indicative on ECG of posterior infarct
ST depression and dominant R waves in leads V1-V2
when does troponin and CK-MB levels peak
troponin peaks at 24-28 hours
CK-MB peaks within 24 hours
location of MI if st elevation in leads V3 + V4
anteroapical
location of MI if ST elevation leads V1 and V2
anteroseptal
antiplatelet of choice for MI if undergoing PCI
ticagrelor or prasugrel
antiplatelet of choice for tretament of MI if undergoing fibrinolysis
clopidogrel
in what location of MI should you avoid nitrates and why
inferior MI (RV infarct) due to risk of hypotension
(also avoid diuretics)
RV relies on preload to maintain stroke volume so with use of nitrates and diuretics which reduce preload = reduced output = hypotension
give IV fluids and inotropes if necessary
contraindications to thrombolysis
ischaemic stroke past 6 months
previous intracranial haemorrhage or GI bleed
known bleeding disorder
recent major surgery/trauma/head injury
what is the timeframe thrombolysis should be performed if used in the management of MI
if PCI not available within 120 mins then treat with thrombolysis i.e. Alteplase (tPA)
should ideally be administered within 3 hours but can be given up to 12 hours after symptom onset (contraindicated if >24 hours)
indications for CABG
triple vessel disease >70% in each vessel
left main CAD
two vessel disease in diabetic
symptomatic patient despite maximal medical therapy
coronary obstruction not ameanable to PCI
after PCI, what is the duration of dual anticoagulants depending on stent type?
bare metal stent = >30 days
drug eluting stent = > 12 months
main complication of RV infarct and how can this be prevented/treated
hypotension
prevent/treat with IV fluids to maintain preload + inotropes if necessary
when is carotid endarterectomy (CEA) recommended in carotid artery stenosis
symptomatic with stenosis 70-99%
consider in symptomatic with stenosis 50-69% or asymptomatic with 60-99%
1st line treatment for patients with hypertriglyceridaemia
lifestyle modification
when is statins considered in patients with hypertriglyceridaemia
if ASCVD risk >7.5% after initial trial of life style modification then statins are considered
indications for testing for dyslipiaemia
screen all patients 35 yrs and older or those >20yrs with risk factors for ASCVD
smokers of all ages should be screened
repeat every 5 years if lipid levels are elevated
why may gemfibrozil be added to the treatment for high cholesterol in patients with ASCVD
gemfibrozil is a fibrate which can reduce risk of pancreatitis
if no history of stroke, MI, PVD, at what LDL level is high intensity started
LDL >190
20-39 FHx ASCVD and LDL >160. ?statin
consider statin
40-75yrs diabetes without ASCVD
moderate or high intensity statin based on 10 yr risk
40-75 yrs and LDL 70-189
10yr risk <20% moderate intensity statin
10yr risk 20 or above then high intensity
