ABIM: Cardiovascular
What is Stable Angina? - correct answer ✔✔reproducible CP or pressure by exertion, emotional stress
>2mo; dx-EKG; (tx-βBlocker-metoprolol, aspirin, statin, ACE-HF <40%, DM, CKD, MI Hx + nitrates, CCB for
angina → ranolazine if refractory, BP<130/ 80)
What is Dihydropyridine CCB? - correct answer ✔✔potent vasodilators; ↓BP, flushing, headache,
edema, hypotension →reflex tachycardia; amlodipine, nifedipine
What is Non-Dihydropyridine CCB? - correct answer ✔✔negative inotropic effects, ↓HR, ↓BP especially
with CKD, DM nephropathy, contraindicated for HF; verapamil, diltiazem
What are Long-acting nitrates? - correct answer ✔✔isosorbide mononitrate, dinitrate, nitroglycerin
patch; SE-headache, flushing, hypotension, particularly with rapid-acting formulations.
What are MI Risk Factors? - correct answer ✔✔smoking, dyslipidemia > DM, HTN, alcohol, obesity,
physical inactivity, diet ↓fruits and ↓vegetables
What is Unstable Angina? - correct answer ✔✔new-onset angina, angina at ↓exertion, rest, ↑frequency
or severity; dx-EKG; (tx-stress EKG or PCI)
What are EKG Abnormalities that prevent Exercise Testing ? - correct answer ✔✔Non-specific ST-T wave
changes, ST segment changes, repolarization abnormalities, LBBB, paced, LVH, pre-excitation/ Wolff-
Parkinson; (tx-pharm stress ECHO, stress nuclear test)
What are Stress EKG Table? - correct answer ✔✔
What is Pharm stress with adenosine or dipyridamole? - correct answer ✔✔LBBB, Pacemaker, patients
unable to reach target HR
,What is Reactive Airway Disease Evaluation? - correct answer ✔✔Dobutamine Stress ECHO, Coronary CT
angiography, Adenosine Single Photon Emission Computed Tomography (not actively wheezing)
What Medications are held for Stress Testing? - correct answer ✔✔βBlocker 24hrs before
What is ST Elevation Myocardial Infarction? - correct answer ✔✔ST segment >1mm, new LBBB; dx-EKG;
(tx-inital presentation, aspirin 325, heparin, P2Y12-prasugral>ticorgrelor, PCI ± TPA if symptoms within
12hrs & PCI not available within 120min; TPA only- aspirin, heparin, clopidogrel, 1 yr)
What are ST Elevation Myocardial Infarction Medications? - correct answer ✔✔βBlocker, ACEi, statin,
prasugrel + daily aspirin; TPA only, BBlocker, ACEi, clopidogral + daily aspirin, 1yr, aldosterone antagonist-
(symptomatic HF- Class 2-4 or EF < 35%; STEMI, EF <40% and symptomatic HF or DM)
What are Cocaine Cardiovascular Affects? - correct answer ✔✔chest pain, HTN; dx-ECG, ST segment
elevation/depression; (tx-PCI + aspirin; pain-nitrates, CCB; BP-CCP; anxiety-benzo)
What is Transfusion for Cardiac Diseases? - correct answer ✔✔MI, orthostatic hypotension, tachycardia
unresponsive to fluids; Hb > 10
What is Non-ST Elevation Myocardial Infarction? - correct answer ✔✔ST segment depression ±
↑troponin; dx-EKG; (tx-initial, aspirin 325, heparin, P2Y12-clopidogrel, PCI within 24hrs; long-term,
βBlocker, statin, aspirin + clopidogrel/ ticagrelor, 1yr)
What are Non-ST Elevation Myocardial Infarction Medications? - correct answer ✔✔βBlocker, statin,
aspirin + clopidogrel/ ticagrelor, 1yr
What ST Elevation Myocardial Infarction Medications ↓Mortality? - correct answer ✔✔β-blocker, ACEi,
Aldosterone antagonists, Aspirin
What is TIMI Score? - correct answer ✔✔-Age ≥65yo
->3 risk factors for CAD (FHx of CAD, HTN, HLD, DM, tobacco use)
-Known CAD (stenosis ≥50%)
-Aspirin use in the past 7 days
, -Severe angina (≥2 episodes in 24 hours)
-ST deviation ≥0.5 mm
-Elevated cardiac marker level
<2, low risk ischemic workup no PCI
What is Dual Antiplatelet Therapy? - correct answer ✔✔-Drug Eluting Stent- prasugrel/ticagrelor +
aspirin,6-12 mo
-Bare Metal Stent-prasugrel/ticagrelor+ aspirin, 4wks
-STEMI, TPA - aspirin +clopidogrel, 12mo
-NSTEMI, no PCI-clopidogrel/ ticagrelor + aspirin, 12mo
-Continue DAPT for total of 30 mo
-Continue aspirin indefinitely
Perioperative: Dual Anti-platelet Therapy - correct answer ✔✔only elective; BMS (30 days), DES (6mo) +
aspirin
Perioperative Management: Valves - correct answer ✔✔mechanical mitral valve (bridge w. LMWH or
UFH); mechanical aortic valve (no bridge)
Perioperative Management: Anti-coagulation - correct answer ✔✔warfarin (5 days, non-valvular afib),
NOACs (2-3 days), (LMWH, 24hrs), IV heparin (4-6hrs); dabigatran, use idarucizumab
Perioperative Management: Anti-platelet - correct answer ✔✔aspirin (5 days), clopidogrel (5-7 days),
NSAIDS/COX2 (1-3 days before)
Perioperative Management: Coronary Artery Disease - correct answer ✔✔Continue β-blockers, statins,
anti-hypertensive meds + aspirin (for stents)
What is Antithrombotic therapy in PCI + Afib? - correct answer ✔✔P2Y12 inhibitor (clopidogrel or
ticagrelor) + rivaroxaban/warfarin)
What is Stable Angina? - correct answer ✔✔reproducible CP or pressure by exertion, emotional stress
>2mo; dx-EKG; (tx-βBlocker-metoprolol, aspirin, statin, ACE-HF <40%, DM, CKD, MI Hx + nitrates, CCB for
angina → ranolazine if refractory, BP<130/ 80)
What is Dihydropyridine CCB? - correct answer ✔✔potent vasodilators; ↓BP, flushing, headache,
edema, hypotension →reflex tachycardia; amlodipine, nifedipine
What is Non-Dihydropyridine CCB? - correct answer ✔✔negative inotropic effects, ↓HR, ↓BP especially
with CKD, DM nephropathy, contraindicated for HF; verapamil, diltiazem
What are Long-acting nitrates? - correct answer ✔✔isosorbide mononitrate, dinitrate, nitroglycerin
patch; SE-headache, flushing, hypotension, particularly with rapid-acting formulations.
What are MI Risk Factors? - correct answer ✔✔smoking, dyslipidemia > DM, HTN, alcohol, obesity,
physical inactivity, diet ↓fruits and ↓vegetables
What is Unstable Angina? - correct answer ✔✔new-onset angina, angina at ↓exertion, rest, ↑frequency
or severity; dx-EKG; (tx-stress EKG or PCI)
What are EKG Abnormalities that prevent Exercise Testing ? - correct answer ✔✔Non-specific ST-T wave
changes, ST segment changes, repolarization abnormalities, LBBB, paced, LVH, pre-excitation/ Wolff-
Parkinson; (tx-pharm stress ECHO, stress nuclear test)
What are Stress EKG Table? - correct answer ✔✔
What is Pharm stress with adenosine or dipyridamole? - correct answer ✔✔LBBB, Pacemaker, patients
unable to reach target HR
,What is Reactive Airway Disease Evaluation? - correct answer ✔✔Dobutamine Stress ECHO, Coronary CT
angiography, Adenosine Single Photon Emission Computed Tomography (not actively wheezing)
What Medications are held for Stress Testing? - correct answer ✔✔βBlocker 24hrs before
What is ST Elevation Myocardial Infarction? - correct answer ✔✔ST segment >1mm, new LBBB; dx-EKG;
(tx-inital presentation, aspirin 325, heparin, P2Y12-prasugral>ticorgrelor, PCI ± TPA if symptoms within
12hrs & PCI not available within 120min; TPA only- aspirin, heparin, clopidogrel, 1 yr)
What are ST Elevation Myocardial Infarction Medications? - correct answer ✔✔βBlocker, ACEi, statin,
prasugrel + daily aspirin; TPA only, BBlocker, ACEi, clopidogral + daily aspirin, 1yr, aldosterone antagonist-
(symptomatic HF- Class 2-4 or EF < 35%; STEMI, EF <40% and symptomatic HF or DM)
What are Cocaine Cardiovascular Affects? - correct answer ✔✔chest pain, HTN; dx-ECG, ST segment
elevation/depression; (tx-PCI + aspirin; pain-nitrates, CCB; BP-CCP; anxiety-benzo)
What is Transfusion for Cardiac Diseases? - correct answer ✔✔MI, orthostatic hypotension, tachycardia
unresponsive to fluids; Hb > 10
What is Non-ST Elevation Myocardial Infarction? - correct answer ✔✔ST segment depression ±
↑troponin; dx-EKG; (tx-initial, aspirin 325, heparin, P2Y12-clopidogrel, PCI within 24hrs; long-term,
βBlocker, statin, aspirin + clopidogrel/ ticagrelor, 1yr)
What are Non-ST Elevation Myocardial Infarction Medications? - correct answer ✔✔βBlocker, statin,
aspirin + clopidogrel/ ticagrelor, 1yr
What ST Elevation Myocardial Infarction Medications ↓Mortality? - correct answer ✔✔β-blocker, ACEi,
Aldosterone antagonists, Aspirin
What is TIMI Score? - correct answer ✔✔-Age ≥65yo
->3 risk factors for CAD (FHx of CAD, HTN, HLD, DM, tobacco use)
-Known CAD (stenosis ≥50%)
-Aspirin use in the past 7 days
, -Severe angina (≥2 episodes in 24 hours)
-ST deviation ≥0.5 mm
-Elevated cardiac marker level
<2, low risk ischemic workup no PCI
What is Dual Antiplatelet Therapy? - correct answer ✔✔-Drug Eluting Stent- prasugrel/ticagrelor +
aspirin,6-12 mo
-Bare Metal Stent-prasugrel/ticagrelor+ aspirin, 4wks
-STEMI, TPA - aspirin +clopidogrel, 12mo
-NSTEMI, no PCI-clopidogrel/ ticagrelor + aspirin, 12mo
-Continue DAPT for total of 30 mo
-Continue aspirin indefinitely
Perioperative: Dual Anti-platelet Therapy - correct answer ✔✔only elective; BMS (30 days), DES (6mo) +
aspirin
Perioperative Management: Valves - correct answer ✔✔mechanical mitral valve (bridge w. LMWH or
UFH); mechanical aortic valve (no bridge)
Perioperative Management: Anti-coagulation - correct answer ✔✔warfarin (5 days, non-valvular afib),
NOACs (2-3 days), (LMWH, 24hrs), IV heparin (4-6hrs); dabigatran, use idarucizumab
Perioperative Management: Anti-platelet - correct answer ✔✔aspirin (5 days), clopidogrel (5-7 days),
NSAIDS/COX2 (1-3 days before)
Perioperative Management: Coronary Artery Disease - correct answer ✔✔Continue β-blockers, statins,
anti-hypertensive meds + aspirin (for stents)
What is Antithrombotic therapy in PCI + Afib? - correct answer ✔✔P2Y12 inhibitor (clopidogrel or
ticagrelor) + rivaroxaban/warfarin)
