Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
85 Cards in this Set
- Front
- Back
What diseases includes Acute coronary syndrome (ACS)? |
1. Unstable angina (UA), 2. non-ST elevation myocardial infarction (NSTEMI), 3. ST-elevation myocardial infarction (STEMI). |
|
Major difference between Stable Angina and ACS? |
ACS should be distinguished from stable angina, which develops during exertion and resolves at rest. |
|
36. Definition of Acute Coronary Syndrome (ACS)? |
a. Causes acute chest pain |
|
37. Best initial therapy for all cases of Acute Coronary Syndrome (ACS)? |
Aspirin |
|
38. Utility of Aspirin?
|
a. It has an INSTANT effect on inhibiting platelets.
b. Aspirin alone reduces mortality by 25% for acute MI and by 50% for “unstable angina,” which may become a non–ST segment elevation MI (NSTEMI). |
|
39. Other drugs that should be administered in Acute Coronary Syndrome (ACS)?
|
a. Nitrates and morphine should also be administered in acute coronary syndromes, but they do NOT lower mortality. |
|
40. What 1 of 2 possible drugs is added to aspirin for all patients w/an acute MI?
|
Prasugrel or Clopidogrel. |
|
42. Do Thrombolytics and primary angioplasty lower mortality in STEMI? |
Yes, both do. |
|
Do Thrombolytics and primary angioplasty lower mortality in NSTEMI? |
NO |
|
43. Primary angioplasty? |
a. Means angioplasty during an acute episode of chest pain. |
|
44. What is the single best evidence for mortality benefit w/angioplasty? |
Infarction. |
|
45. When must “percutaneous coronary intervention” (PCI) be performed for Acute Coronary Syndrome (ACS) STEMI?
|
a. Within 12 hours of the onset of ischemic b. Within 90 minutes of arrival at the emergency department |
|
46. If Primary Coronary Intervention cannot be performed within 90 minutes of arrival in the emergency department, what should be done? |
a. The patient should receive thrombolytics. |
|
Tx. for pt. with STEMI but Late presentation (>12 hours after symptom onset)? |
Coronary artery bypass grafting (CABG). |
|
47. When are thrombolytics indicated?
|
a. When the pt has chest pain for <12 hours
b. AND c. Has ST segment elevation in 2 or more leads. d. A new Left Bundle Branch Block (LBBB) is also an indication for thrombolytic therapy. |
|
48. When should thrombolytics be given?
|
Within 30 minutes of a pt’s arrival in the ED w/pain. |
|
Absolute Contraindications to thrombolytic therapy? |
• Active bleeding or bleeding diathesis |
|
49. When is the answer “urgent angioplasty” or PCI? |
a. The question asks “what has the single greatest efficacy?” in lowering mortality in STEMI. |
|
50. Utility of β–blockers for Acute Coronary Syndrome?
|
a. β–blockers lower mortality, but the timing of their administration is NOT critical. |
|
51. Utility of Ace inhibitors and Angiotensin receptor blockers (ARBs)?!
|
Should be given to all pts w/an acute coronary syndrome, but they only lower morality if there is left ventricular disfunction or systolic dysfunction!!
|
|
52. Other tests to run w/acute coronary syndrome?
|
Make sure there is a lipid profile and start the pt on HMG CoA reductase inhibitors (statins), if indicated i.e., if LDL is not at goal.
|
|
53. A 72 yo man comes to the emergency department having had chest pain for the last hour. His initial EKG shows ST segment elevation in leads V2–V4. Aspirin has been given. Which of the following will most likely benefit this pt?
|
Angioplasty. |
|
54. Utility of Statins such as atorvastatin with Acute Coronary Syndrome?
|
Statins should be given to all patients w/acute coronary syndrome, regardless of what the EKG shows or troponin or CK–MB levels.
|
|
55. 6 drugs/classes/therapies that always lower mortality when used in Acute Coronary Syndrome?
|
1. Aspirin
2. Thrombolytics 3. Primary angioplasty 4. Metoprolol 5. Statins 6. Clopidogrel or prasugrel. |
|
56. 2 classes of drugs that Lower mortality in certain conditions w/Acute Coronary Syndrome?
|
a. Ace inhibitors if ejection fraction is low
b. ARBs if ejection fraction is low. |
|
57. 6 classes of drugs that do not lower mortality in Acute Coronary Syndrome?
|
1. Morphine
2. Oxygen 3. Nitrates 4. Calcium Channel blockers 5. Lidocaine 6. Amiodarone |
|
58. When is Prasugrel or Clopidogrel the answer w/ACS?
|
a. When a platelet antagonist is to be used for acute chest pain, there is aspirin allergy, the patient is to undergo angioplasty, or an acute infarction is occurring.
b. Add wither clopidogrel or Prasugrel to aspirin when there is an acute MI. |
|
How long a pt. with STEMI should take clopidogrel? |
1. At least a month after fibrinolytic therapy, or 2. Up to 9–12 months after stent implantation, depending on the type of stent used. |
|
When Clopidogrel should be avoided? |
In patients likely to require emergency coronary bypass surgery. Prasugrel and ticagrelor are alternatives to clopidogrel. If possible, clopidogrel should be discontinued 5 days before coronary bypass surgery. |
|
59. AE of Ticlopidine?
|
Neutropenia.
|
|
60. When are calcium channel blockers (verapamil, diltiazem) the answer w/ACS (3 things)?
|
1. If the pt has an INTOLERANCE to beta blockers, such as severe asthma.
2. If there is cocaine–induced chest pain 3. There is coronary vasospasm/Prinzmetal’s angina. |
|
61. When is a pacemaker the answer for acute MI (5 things)?
|
1. 3rd degree AV block
2. Mobitz II, second–degree AV block 3. Bifascicular block 4. New left bundle branch block 5. Symptomatic bradycardia |
|
62. When is lidocaine or amiodarone the answer for acute MI?
|
a. ONLY when there is ventricular tachycardia or ventricular fibrillation.
b. Do not give antiarrhythmic medications to prevent ventricular arrhythmias!!! |
|
63. 3 times when Prasugrel or Clopidogrel is used?
|
1. When there is aspirin allergy
2. The pt undergoes angioplasty and stenting 3. There is acute MI. |
|
64. Prasugrel vs. Clopidogrel?
|
Prasugrel has greater efficacy than clopidogrel but causes more bleeding.
|
|
65. Complications of MI?
|
All the complications of MI result in HYPOTENSION.
|
|
67. 2 Diagnostic tests for Cardiogenic shock?
|
a. Echo
b. Swan–Ganz (right heart) catheter |
|
68. Tx of Cardiogenic shock?
|
a. ACEI
b. Urgent revascularization |
|
69. Diagnostic test for Valve rupture?
|
Echo
|
|
70. Tx of valve rupture?
|
a. ACEI
b. Nitroprusside c. Intra–aortic balloon pump as a bridge to surgery. |
|
71. 2 Diagnostic tests for Septal Rupture?
|
a. Echo
b. Right heart catheter showing a step up in saturation from the right atrium to right ventricle. |
|
72. Tx of Septal Rupture?
|
a. ACEI
b. Nitroprusside c. Urgent surgery |
|
73. Diagnostic test for Myocardial wall rupture?
|
Echo
|
|
74. Tx of Myocardial wall rupture?
|
a. Pericardiocentesis
b. Urgent cardiac repair |
|
75. Tx of Sinus bradycardia?
|
Atropine, followed by pacemaker if there are still symptoms.
|
|
76. Diagnostic test for third–degree (complete) heart block?
|
EKG, Canon “a” waves.
|
|
77. Tx of third–degree (complete) heart block?
|
Atropine and a pacemaker even if symptoms resolve.
|
|
78. Treatment of right ventricular infarction?
|
Fluid loading
|
|
79. Post–MI discharge instructions–all patients post–MI should go home on..?
|
a. Aspirin |
|
80. A pt’s wife comes to take her husband home after an MI and asks how long they should wait before they have sex. What do you tell her?
|
2–6 weeks |
|
81. Main differences for the treatment of Non–ST Segment from STEMI? |
a. No thrombolytic use |
|
When Glycoprotein IIb/IIIa inhibitors (tirofiban or eptifibatide)? |
Tirofiban or eptifibatide is particularly recommended in high-risk patients with UA/NSTEMI in whom an invasive strategy is planned. |
|
82. A 54 yo man w/a hx of DM and HTN comes to the ED w/crushing, substernal chest pain that radiates to his left arm. The pain has been on and off for several hours, w/this last episode being 30 minutes in duration. He has had chest pain on exertion before, but this is the first time it has developed at rest. The EKG is normal. Aspirin, Oxygen, and nitrates have been given. Troponin levels are elevated. Which of the following is most likely to benefit this pt? |
Answer: A |
|
When unfractionated heparin or subcutaneous enoxaparin should be given? |
until angiography or for 48–72 hours |
|
In what patients the enoxaparin dose must be reduced? |
with impaired renal function |
|
83. What is the single greatest benefit from GPIIb/IIIa inhibitors w/ACS?
|
The single greatest benefit is in combination w/angioplasty and stent placement. |
|
84. Does Abciximab benefit ST segment elevation MI (GPIIb/IIIa inhibitor)?
|
No
|
|
85. When are thrombolytics used for ACS?
|
Only if there is ST segment elevation or a new LBBB within 12 hours of the onset of chest pain.
|
|
86. Value of ARBs?
|
ARBs are used interchangeably w/ACE inhibitors, especially if the patient has a cough w/ACE inhibitors
|
|
87. Common SE to both ACEs and ARBs?
|
Both cause hyperkalemia.
|
|
88. Tx of stable angina?
|
a. Aspirin and Metoprolol.
b. These are the 2 main routinely indicated meds bc of their benefit on mortality c. Nitrates should be used for angina pain but they do not lower mortality. |
|
89. With what 3 complications associated with stable angina should ACE inhibitors and ARBs be used?
|
1. CHF
2. Systolic dysfunction 3. Low ejection fraction. |
|
90. Primary use of Coronary Angiography?
|
a. Used to determine who is a candidate for coronary artery bypass grafting (CABG).
b. You do no need to do angiography to diagnose CAD. |
|
91. Stress testing vs. coronary angiography?
|
a. Stress testing can show reversible ischaemia.
b. However, you MUST do angiography to see who needs CABG. |
|
92. When do you not need angiography for Stable angina?
|
To initiate:
1. Aspirin + metoprolol (mortality benefit) 2. Give nitrates (pain) 3. ACE/ARB (low ejection fraction). 4. Clopidogrel or Prasugrel (acute MI or cannot tolerate aspirin) 5. Statins (LDL >70–100) |
|
93. What is the main difference between saphenous vein grafts and internal mammary artery grafts?
|
a. Internal mammary artery grafts remain open for 10 years.
b. Vein grafts become occluded after 5 years. c. There is no difference in the need for medications. |
|
94. Indications for CABG (2)?
|
1. 3 coronary vessels with 70% stenosis
2. Left main coronary artery stenosis |
|
95. 4 Coronary artery disease equivalents?
|
1. Diabetes Mellitus
2. Peripheral artery disease 3. Aortic disease 4. Carotid disease |
|
96. Single strongest indication for lipid–lowering therapy with a statin?
|
A pt w/an acute coronary syndrome and an LDL >130.
|
|
97. Goal of therapy for LDL in those w/ CAD?
|
LDL <130.
|
|
When to answer “statin therapy” for ANY case of CAD or an EQUIVALENT w/an LDL >100?
|
Note: although there is strong evidence for an LDL < 130, you will answer “statin therapy” for ANY case of CAD or an EQUIVALENT w/an LDL >100.
|
|
99. If a question asks for the LDL goal in a pt w/DM, the answer is?
|
LDL < 70.
|
|
101. Risk factors in lipid management?
|
1. Tobacco use
2. HTN (≥140/90) or on BP meds! 3. Low HDL cholesterol (<40) 4. Family hx of early coronary heart disease (female relatives <65, male relatives < 55). 5. Age (males ≥45, females ≥55). |
|
102. Many meds, such as statins, cholestyramine, gemfibrozil, ezetimibe, and niacin, lower LDL, lower triglycerides, and total cholesterol, and raise HDL. Which of the following is the most important reason for using Statins?
|
Greatest mortality benefit.
|
|
103. When is the goal of therapy an LDL <70 (2 things)?
|
Coronary Artery Disease and diabetes |
|
104. Most common adverse effet of statins?
|
a. Liver toxicity.
b. As many as 1% of pts will stop taking statins because of an elevation of transaminases. c. LFTs should be routinely checked. d. Rhabdo is NOT the most common AE. |
|
105. Is there a routine indication to check CPK with statins?
|
No
|
|
106. A man develops erectile dysfunction after an infarction. What is the most common cause?
|
a. Anxiety
b. Anxiety is the most common cause of erectile dysfunction postinfarction. Although beta blockers may be the most common medication associated w/ED, anxiety is still a more common cause of erectile dysfunction that beta blockers. |
|
107. A man develops erectile dysfunction postinfarction. You are planning to start sildenafil. Which med must you stop? |
Nitrates. |
|
Area of Infarction and Artery Involved if EKG Changes (Q Waves, ST Elevation, |
Inferior Wall Right coronary |
|
Area of Infarction and Artery Involved if EKG Changes (Q Waves, ST Elevation, |
Anteroseptal Wall Left anterior descending |
|
Area of Infarction and Artery Involved if EKG Changes (Q Waves, ST Elevation, |
Anterior Wall Left anterior descending |
|
Area of Infarction and Artery Involved if EKG Changes (Q Waves, ST Elevation, |
Lateral Wall Left anterior descending or circumflex |
|
Area of Infarction and Artery Involved if EKG Changes (Q Waves, ST Elevation, |
Posterior Wall Posterior descending |
|
Tx. of inferior MIs. |
Fluids. |