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32 Cards in this Set
- Front
- Back
What are endpoints for positive ECG stress test?
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ST depression
Heart failure Ventricular arrythmia |
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What are indications for catheterization?
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Positive stress test
Medically refractory angina Angina with equivocal noninvasive tests Angina occuring soon after MI |
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Pharmacological agents used in management of stable angina?
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Aspirin, betablockers in all - reduce mortality
Nitrates - symptomatic relief +/- Ca channel blockers (if beta blockers and nitrates are ineffective) |
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Management of mild, moderate and severe stable angina?
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mild - Nitrates and betablocker +/- Ca channel blocker
moderate mild regimen +/- angiography for possible revascularization Severe - angiography and possible CABG |
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What differentiates mild from moderate from severe stable angina?
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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 |
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Diagnostic considerations in unstable angina pectoris?
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stabilize before stress test
consider cardiac cath without stress test |
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What pharmacological agents are used in unstable angina pectoris?
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Aspirin
Beta blockers - first line Nitrates - first line LMWH G IIb/IIIa inhibitors if PTCA or stenting |
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Guidelines for heparin use in unstable angina (duration of therapy, coagulation test goals, ideal formulation?)
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continue therapy for 2 days
PTT is kept at 2 to 2.5 enoxaparin |
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If managing unstable angina conservatively, when should cath be done in a stable patient?
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If ECG changes persist after 48 hours
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What treatment should patients with unstable angina be sent home on?
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aspirin, beta blockers, nitrates
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Definitive diagnostic test for variant angina?
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angiography with ergonovine
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Treatment for variant angina?
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Ca channel blockers, Nitrates
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ECG changes in posterior infarct?
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Large R wave in V1-2
ST depression in V1-2 Upright prominent T's in V1-2 |
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Time course for CK-MB?
When should it be measured? |
elevated 4-8 hours after onset
Peak at 24 hours Normal at 24-48 hours On admission, every 8 hours for 24 hours |
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Time course for troponins?
When should it be measured? |
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 |
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Pharmacologic therapy for MI?
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Aspirin, Betablocker, ACE inhibitors reduce mortality
Statins reduce risk of further coronary events - use as maintenance O2, Nitrates, morphine, heparin |
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Indications and time course for fibrinolysis?
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ST elevation in 2 contiguous ECG leads with pain onset within 6 hours refractory to nitroglycerin
Given within 24 hours, best if within 6 |
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Contraindications to thrombolysis?
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uncontrolled HTN (>180/110)
Truama to head or from CPR Peptic Ulcer disease Previous stroke Invasive procedure or surgery Dissecting aortic aneurysm |
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What are conditions for which you should transfer to a facility with cath over doing fibrinolysis even if the facility is >2 hrs away
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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 |
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What are guidelines for management of RV infarction?
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volume loading
diuretic avoidance venodilator avoidance maintenance of AV synchrony with pacing |
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Arrythmias following MI: Management for
Vtach? V-fib? PVCs? PSVT? Sinus bradycardia? Asystole? AV block? |
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 |
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How should recurrent infarction be diagnosed and treated?
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CK-MB check at 36-48 hours
repeat thrombolysis or cath |
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When does free wall rupture occur following MI?
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1-4 days after most likely
within 2 weeks in almost all cases |
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When does rupture of intraventricular septum occur?
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within 10 days of MI
|
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What is the best diagnostic test for papillary muscle rupture?
Management? |
echo
emergent surgery with replacement Afterload reduction with nitroprusside, intraaortic balloon pump |
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management of ventricular pseudoaneurysm following surgery?
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bedside echo for dx and emergent surgery
|
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What does ventricular aneurysm raise risk of?
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tachyarrhythmias
|
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Management of ventricular aneurysm?
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surgery to remove aneurysm in some patients
medical management is protective |
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Treatment of acute pericarditis following MI?
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Aspirin
NSAIDs, corticosteroids are contraindicated |
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Presentation of Dressler's syndrome?
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fever, malaise, pericarditis, leukocytosis, pleuritis
weeks to months after MI |
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Treatment of Dressler's syndrome?
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aspirin is most effective
|
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Features of syndrome X?
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exertional angina with normal arteriogram
Exercise testing, nuclear imaging show evidence of MI |