Cards: Ischemic Heart Disease

Front 1

What are endpoints for positive ECG stress test?

Back 1

ST depression
Heart failure
Ventricular arrythmia

Front 2

What are indications for catheterization?

Back 2

Positive stress test
Medically refractory angina
Angina with equivocal noninvasive tests
Angina occuring soon after MI

Front 3

Pharmacological agents used in management of stable angina?

Back 3

Aspirin, betablockers in all - reduce mortality
Nitrates - symptomatic relief
+/- Ca channel blockers (if beta blockers and nitrates are ineffective)

Front 4

Management of mild, moderate and severe stable angina?

Back 4

mild - Nitrates and betablocker +/- Ca channel blocker

moderate mild regimen +/- angiography for possible revascularization

Severe - angiography and possible CABG

Front 5

What differentiates mild from moderate from severe stable angina?

Back 5

mild - normal EF, single vessel disease

moderate - normal EF, two vessel disease

severe - decreased EF, three vessel disease or left main disease or LAD disease

Front 6

Diagnostic considerations in unstable angina pectoris?

Back 6

stabilize before stress test
consider cardiac cath without stress test

Front 7

What pharmacological agents are used in unstable angina pectoris?

Back 7

Aspirin
Beta blockers - first line
Nitrates - first line
LMWH
G IIb/IIIa inhibitors if PTCA or stenting

Front 8

Guidelines for heparin use in unstable angina (duration of therapy, coagulation test goals, ideal formulation?)

Back 8

continue therapy for 2 days
PTT is kept at 2 to 2.5
enoxaparin

Front 9

If managing unstable angina conservatively, when should cath be done in a stable patient?

Back 9

If ECG changes persist after 48 hours

Front 10

What treatment should patients with unstable angina be sent home on?

Back 10

aspirin, beta blockers, nitrates

Front 11

Definitive diagnostic test for variant angina?

Back 11

angiography with ergonovine

Front 12

Treatment for variant angina?

Back 12

Ca channel blockers, Nitrates

Front 13

ECG changes in posterior infarct?

Back 13

Large R wave in V1-2
ST depression in V1-2
Upright prominent T's in V1-2

Front 14

Time course for CK-MB?

When should it be measured?

Back 14

elevated 4-8 hours after onset
Peak at 24 hours
Normal at 24-48 hours

On admission, every 8 hours for 24 hours

Front 15

Time course for troponins?

When should it be measured?

Back 15

elevated in 3-5 hours
return to normal in 5-14 days
peak at 24-48 hours

On admission, every 8 hours for 24 hours

Front 16

Pharmacologic therapy for MI?

Back 16

Aspirin, Betablocker, ACE inhibitors reduce mortality

Statins reduce risk of further coronary events - use as maintenance

O2, Nitrates, morphine, heparin

Front 17

Indications and time course for fibrinolysis?

Back 17

ST elevation in 2 contiguous ECG leads with pain onset within 6 hours refractory to nitroglycerin

Given within 24 hours, best if within 6

Front 18

Contraindications to thrombolysis?

Back 18

uncontrolled HTN (>180/110)
Truama to head or from CPR
Peptic Ulcer disease
Previous stroke
Invasive procedure or surgery
Dissecting aortic aneurysm

Front 19

What are conditions for which you should transfer to a facility with cath over doing fibrinolysis even if the facility is >2 hrs away

Back 19

contraindications to fibrinolysis
STEMI presents more than 12 hours after symptom onset and residual ST elevation or complicated presentation (heart failure, high grade ventricular arrhythmia, shock)
STEMI in patients with bypass graft
Cardiogenic shock

Front 20

What are guidelines for management of RV infarction?

Back 20

volume loading
diuretic avoidance
venodilator avoidance
maintenance of AV synchrony with pacing

Front 21

Arrythmias following MI: Management for

Vtach?
V-fib?
PVCs?
PSVT?
Sinus bradycardia?
Asystole?
AV block?

Back 21

Vtach - cardiovert if unstable
If stable follow for 48 hours on telemetry, treat after 48 hours

V-fib - cardiovert immediately

PVCs - conservative management

PSVT - Rx as usual (valsalva, adenosine)

Sinus brady - atropine if symptomatic otherwise observe

Asystole - transcutaneous pacing

AV block - IV atropine initially

Front 22

How should recurrent infarction be diagnosed and treated?

Back 22

CK-MB check at 36-48 hours

repeat thrombolysis or cath

Front 23

When does free wall rupture occur following MI?

Back 23

1-4 days after most likely
within 2 weeks in almost all cases

Front 24

When does rupture of intraventricular septum occur?

Back 24

within 10 days of MI

Front 25

What is the best diagnostic test for papillary muscle rupture?

Management?

Back 25

echo

emergent surgery with replacement
Afterload reduction with nitroprusside, intraaortic balloon pump

Front 26

management of ventricular pseudoaneurysm following surgery?

Back 26

bedside echo for dx and emergent surgery

Front 27

What does ventricular aneurysm raise risk of?

Back 27

tachyarrhythmias

Front 28

Management of ventricular aneurysm?

Back 28

surgery to remove aneurysm in some patients
medical management is protective

Front 29

Treatment of acute pericarditis following MI?

Back 29

Aspirin

NSAIDs, corticosteroids are contraindicated

Front 30

Presentation of Dressler's syndrome?

Back 30

fever, malaise, pericarditis, leukocytosis, pleuritis
weeks to months after MI

Front 31

Treatment of Dressler's syndrome?

Back 31

aspirin is most effective

Front 32

Features of syndrome X?

Back 32

exertional angina with normal arteriogram
Exercise testing, nuclear imaging show evidence of MI