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Cardiology - ABIM
STEMI and white sheet facts
| Question | Answer |
|---|---|
| In atrial fibrillation not due to valvular disease, at what point should these patients be anticoagulated? | When CHA2DS2-Vasc > 1 |
| After PCI, what should a patient with chronic atrial fibrillation be on for anticoagulation? | Warfarin, aspirin, clopidogrel/ticagrelor |
| How to treat acute pericarditis in a hemodynamically stable patient? | Use an anti-inflammatory like naproxen |
| How to treat acute pericarditis after an MI? | Aspirin |
| Risk stratify a patient with normal EKG. What study should be used? | Exercise stress test |
| Risk stratify a patient with newly diagnosed CHF and high risk for CAD. What test should be used? | Stress test or cardiac catheterization |
| How to risk stratify a patient with stable angina not controlled on optimal medical therapy? | Cardiac catheterization |
| What should a patient be on if a drug alluding stent was placed during PCI? How long should the patient be on that regimen? | aspirin, clopidogrel/ticagrelor for at least one year |
| What kind of cardiac valve should be used in a patient with contraindication to anticoagulation? | Bio prosthetic valve |
| What medications should a patient be on after an MI? | Aspirin, beta blocker, statin, ACEi |
| After an ST elevation MI, what should a patient be on as an inpatient? | Aspirin, clopidogrel, low molecular weight heparin |
| If a patient with an ST elevation MI gets tPA, what other medication should be added? | Clopidogrel |
| What are the three indications for patients who should get cardiac resynchronization? | 1. EF=<35%, 2. LBBB + QRS > 150, 3. NYHA 3-4 on max med |
| What are the indications for an ICD (cardioverter defibrillator)? | 1. EF=<35%, 2. NYHA 2-3 |
| What is the frequency of monitoring for a patient with Marfan syndrome and aortic root dilation? | Six months after the initial diagnosis, then annually |
| What is the frequency of monitoring for a patient with bicuspid aortic valve with an aortic diameter of greater than or equal to 4.5 cm? What study should be used? | TTE annually |
| What study should be used to monitor moderate asymptomatic aortic stenosis? At what frequency? | TTE every one to two years |
| What study should be used to monitor severe asymptomatic aortic stenosis? At what frequency? | TTE every 6 to 12 months |
| Who should be screened for AAA? | one-time ultrasonographic screening in men aged 65 to 75 years who are active or former smokers |
| What is the strongest risk factor for the rupture of an AAA | strongest risk factor for the rupture of an AAA is maximal aortic diameter |
| frequency of monitoring if AAA maximum diameter is 3.5 to 4.4 cm | If AAA maximum diameter is 3.5 to 4.4 cm, repeat ultrasonography is recommended annually |
| frequency of monitoring if AAA maximum diameter is 4.5 to 5.4 cm | 4.5 to 5.4 cm, repeat ultrasonography should be performed every 6 to 12 months |
| when should you elect to do a repair of AAA be considered for men? For women? | Elective repair should be considered for 1. AAA of 5.5 cm in diameter for men, 5.0 cm for women, 2. for those that increase in diameter by more than 0.5 cm within a 6-month interval, and 3. for those that are symptomatic (tenderness or abdominal or back p |
| What is the most important modifiable risk factor for AAA? | Smoking |
| what is the most important treatment or an STEMI? | reperfusion via PCI or tPA. |
| what should you be thinking about if you have a patient with STEMI and now has hypotension? | Ventricular wall rupture or cardiogenic shock |
| What should you be thinking about if you have a patient with STEMI and now has a new apical heart murmur? | Acute mitral regurgitation |
| In a patient with STEMI, what should happen if PCI cannot within 120 minutes? | When PCI cannot be readily achieved within 120 minutes, thrombolytic therapy is recommended in those patients without contraindications |
| What should you do for a patient who has accelerated video ventricular rhythm hours after tPA? | Nothing. accelerated idioventricular rhythm (AIVR); AIVR is considered a benign rhythm when it occurs within 24 hours of reperfusion |
| What should you do 60 minutes after completion of tPA? | Check EKG to make sure that ST elevation has resolved. |
| name a glycoprotein IIb/IIIa inhibitor | abciximab |
| When should you not give a beta blocker for a STEMI? | In the treatment of STEMI, β-blockers are recommended at the time of initial presentation except in patients with evidence of heart failure, hypotension, bradycardia, advanced atrioventricular block, or other contraindications to β-blockers. |
| After reperfusion in a STEMI, what medication should you give? When is that medication contraindicated? | ACE inhibitors should be administered after reperfusion in all patients without contraindications (systolic blood pressure <90 mm Hg, advanced kidney dysfunction, hyperkalemia). |
| In a STEMI pt, what is the preferred dual anti platelet therapy after PCI? What is preferred after tPA? | After PCI, use aspirin and ticagrelor or prasugrel. After tPA, use aspirin and clopidogrel. |
| How long should dual anti platelet therapy be continued after a STEMI? | ASA and either clopidogrel, or ticagrelor/prasugrel for at least one year. 4 weeks if bare metal stent. |
| When are glycoprotein IIb/IIIa inhibitors (abciximab, tirofiban, eptifibatide) given? | In the cath lab for STEMI patients undergoing primary PCI. |
| What does a STEMI mean physiologically? | STEMI is a complete occlusion of an cardio coronary artery |
| What EKG changes will you see for a STEMI? | ST elevation in two consecutive leads or a new left bundle branch block |
| What does it mean if you have ST depressions in leads V1 through V4? | Transmural posterior MI |
| What reperfusion strategy is preferred if a patient shows up with the STEMI and is greater than four hours since symptom onset? | PCI |
| What reperfusion strategy is preferred if a patient has CHF and shows up with a STEMI? | PCI |
| What reperfusion strategy is preferred if a STEMI pt shows up in cardiogenic shock? | PCI |
| What is the door to balloon time if a STEMI patient shows up at a PCI facility? | 90 min |
| What is the door to balloon time if a STEMI patient shows up at a facility that is not PCI enabled and we have to send them to a PCI facility? | 120 minutes |
| What should happen if a patient has no access to a PCI facility? | Patient should get tPA within 30 minutes of arrival |
| What are the 6 absolute contraindications to tPA? | Prior cerebral hemorrhage, any cerebrovascular lesion such as an AVM, ischemic stroke in the last three months, closed head trauma or facial trauma in the last three months, active bleeding or bleeding disorder, suspected aortic dissection |
| What are 13 relative contraindications to tPA? | H/o bad HTN; SBP>180 DBP>110 (can get tPA if lower to 140/90); >10min CPR; h/o isch stroke >3 mo; <2-4wk p int blding; <3wk p maj surgery; demen; intracranial dz; non compr vasc punc; prior streptokinase; current anticoag; pregn |
| What is the initial therapy for patients who presents with STEMI? | Aspirin, beta blocker, nitrates, unfractionated or low molecular weight heparin (unfractionated heparin preferred if patient going to PCI) |
| If a STEMI patient goes directly to PCI, what should the patient get prior to the procedure? | ticagrelor |
| after PCI, what should the STEMI patient be discharged with? | Aspirin, beta blocker, nitrates, ACE inhibitor, statin, ticagrelor |
| If after tPA, if a STEMI patient has EF less than 40%, what should happen? | Patient goes to the Cath Lab |
| If after tPA, if a STEMI patient still has clinically significant ischemia, what should happen? | Patient goes to the Cath Lab |
| What does CHA2DS2-VASc stand for and what is the score breakdown? | 1 CHF 1 HTN or antiHTNmed 2 Age >75+ 1 DM 2 Stroke/TIA/thromboembolism in brain (any cerebral ischemia) 1 Vascular disease (prior MI, PAD, CAD) 1 Age 65 to 74 1 Sex Female |
Created by:
christinapham
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