0(M) or 1(F) - no anticoag
1(M) or 2(F) - shared decision-making
2(M) or 3(F) - anticoag
ACC/AHA 2019
Quiz :How soon is troponin detected after ACS?
How long is it elevated for? - Answer :Detected 3-6 hrs after ACS
Elevated for 7-14d post-MI
*Renal dx can show elevated trops
Quiz :Tx cocaine-induced angina? What do we NOT give? -
Answer :Nitroglycerin, benzos
**Do NOT give beta blockers to avoid unopposed alpha stimulation
Quiz :Management of NSTEMI (NSTE-ACS), low and high risk strategies? -
Answer :Lower Risk Patients (Ischemia guided strategy):
1. ASA 325mg
2. P2Y12i (Clopidogrel)
3. Anticoag (SQH)
,Higher Risk Patients (Early Invasive strategy):
On the way to the CATH lab...
1. ASA 325
2. P2Y12i (Clopidogrel)
3. Anticoag (SQH)
4. Consider glycoprotein IIa/IIIbi (abciximab)
Quiz :When do we consider higher risk strategy for treatment of NSTEMI
(NSTE-ACS)? - Answer :-sx ischemia despite med tx
-prev PCI or CABG
-evidence of cardiac dx (EF < 40%, large ant perfusion defect, marked elevated
trop, ventricular dysrhythmias)
Quiz :Management of STEMI? - Answer :1. Reperfusion (cath lab) ASAP! - w/i
12 hrs!!
2. PCI preferred
3. If > 12 hrs away from PCI capable facility or if time from 1st medical contact
at non-PCI hospital to device time @ PCI hospital is > 2 hrs, consider
fibrinolytics
Quiz :What arteries and leads are affected in anterior MI, lateral MI, and
inferior MI? - Answer :Ant MI:
-LAD
-V1-V4
Lat MI:
-circumflex
-V5-V6
Inferior MI:
-RCA
-II, III, AVF
Quiz :How long is DAPT needed for: 1) Acute ACS?
2) scheduled cath w/ BMS vs DES? - Answer :1. Acute ACS: 1 yr of DAPT
regardless of stent type*
2. Scheduled cath: 1 month of DAPT for BMS, 6 mos for DES
,*Extending DAPT beyond 1 yr after MI may be reasonable if no increased risk
of bleed
Quiz :What are the 4 indicators for statin therapy? - Answer :1. Tertiary
prevention for known CVD: ACS, PVD, prior MI/angina/stroke/TiA, prior PCI
2. Secondary prevention in familial HLD w/ LDL 190+
3. DM age 40-75 + LDL 70+
4. Age 40-75 + LDL 70+ + 10 yr ASCVD risk:
7.5% or higher - discuss statin
7.5 -10% - consider statin if risk enhancers
10% or higher - start statin (low-mod)
Quiz :What is primary, secondary, tertiary, and quaternary prevention?
Give examples for each. - Answer :Primary prevention - targets people w/ risk
factors to prevent a disease (ex: vaccinations)
Secondary prevention - targets people w/ an asx disease to catch it early (ex:
breast cancer screening)
Tertiary prevention - targets people w/ known disease to prevent
complications (screening diabetics for microalbuminuria)
Quaternary prevention - goal of preventing over-treatment (no ASA for
primary prevention, avoiding unnecessary clinical breast exams or DRE)
Quiz :When is coronary artery calcium score useful? - Answer :Used to help
aid decision to start statin in:
-Adults 40-75 with no clinical ASCVD or DM
-w/ LDL at least 70
-ASCVD risk 7.5-19.9%
Score 0 - may hold statin
Score 1-99 + age at least 55 - start statin
Score at least 100 - start statin
Quiz :5 Important meds in MI? - Answer :1. ACEi
2. BB
3. Statin
4. ASA
5. Anticoag (LVX or SQH)
, Quiz :4 Important meds in HF (that decrease mortality)? - Answer :1. ACEi or
ARBs
2. BB - metoprolol succinate, carvedilol, and bisoprolol ONLY
*start when stable
3. Aldosterone antags - if GFR > 30
4. Entresto (ARNI) - 36 hrs after stopping ACE/ARBs
Quiz :In African Amer's w/ HFrEF, what med combo causes decreased
mortality and increased quality of life? - Answer :Hydralazine + isosorbide
dinitrate
Quiz :What common drugs do we avoid in HFrEF? - Answer :1. NSAIDs
2. non-dihydropyridine calcium channel blockers (verapamil, diltiazem)
*think "non-dihydro - neg inotropes!"
3. Most antiarrhythmics
4. TZDs (pioglitazone) - d/t water retention
Quiz :What med helps in HFpEF? When do we use it? - Answer :Aldosterone
antags if:
GFR > 30, K <5, Cr < 2.5
Quiz :What are indications for ICD placement in advanced heart failure? -
Answer :-EF < or equal to 35%
-NYHA class II or III
-Life expectancy > 1 yr
Quiz :An increase in blood pressure of how much is directly related to risk of
major cardiac event? - Answer :For every 20mmHg increase in SBP and
10mmHg increase in DBP
Your risk of major CV event/stroke DOUBLES!
Quiz :Definition of pediatric HTN? When do we start checking kids' BP? -
Answer :> or equal to 95%ile in BP for age, gender, and height
Start measuring BP at 3 yrs old
Quiz :When do you work up pediatric HTN? What is the workup involved? -
Answer :-NOT obese (Obesity is #1 cause)
-No FHx HTN
The benefits of buying summaries with Stuvia:
Guaranteed quality through customer reviews
Stuvia customers have reviewed more than 700,000 summaries. This how you know that you are buying the best documents.
Quick and easy check-out
You can quickly pay through credit card for the summaries. There is no membership needed.
Focus on what matters
Your fellow students write the study notes themselves, which is why the documents are always reliable and up-to-date. This ensures you quickly get to the core!
Frequently asked questions
What do I get when I buy this document?
You get a PDF, available immediately after your purchase. The purchased document is accessible anytime, anywhere and indefinitely through your profile.
Satisfaction guarantee: how does it work?
Our satisfaction guarantee ensures that you always find a study document that suits you well. You fill out a form, and our customer service team takes care of the rest.
Who am I buying these notes from?
Stuvia is a marketplace, so you are not buying this document from us, but from seller HELLENAH. Stuvia facilitates payment to the seller.
Will I be stuck with a subscription?
No, you only buy these notes for £7.81. You're not tied to anything after your purchase.