Carotids - Answer supply blood to the brain, face and neck
Carotid disease - Answer causes ischemia from both hypoperfusion and atheroembolic events and presents w/ various symptoms
ABCD scoring for stroke risk - Answer Age>60 = 1 point
BP >140/90 = 1 point
Unilateral weaknes...
NURS 5463 Cardiac Latest Exam
Questions Fully Solved.
Carotids - Answer supply blood to the brain, face and neck
Carotid disease - Answer causes ischemia from both hypoperfusion and atheroembolic events and
presents w/ various symptoms
ABCD scoring for stroke risk - Answer Age>60 = 1 point
BP >140/90 = 1 point
Unilateral weakness = 2 points,
speech impairment w/o weakness = 1 point
DM = 1 point
Stroke risk based on scores:
0-3 = 1.2% stroke in 7 days
4-5 = 5.4% stroke in 7 days
5-6 = 11.7% stroke in 7 days
Vaso vesorum - Answer patients with atherosclerosis have a higher density of vasa vasorum - smaller
vessels that supply blood to the walls of larger vessels
Exercise - Answer counteracts the proatherosclerotic conditions of HTN, DM, HLD, which can disrupt
endothelial response to laminar shear stress
Carotid artery disease exam - Answer carotid bruit when auscultating the neck on the ipsilateral side of
stenosis
Digital subtraction angiography (DSA) - gold standard diagnostic tool for carotic atherosclerosis, and is a
required part of treatment with carotid stenting, allows for direct visualization and can measure the
velocity of flow -- not commonly done for routine diagnosis
Statins - Answer lipid modulating and anti-inflammatory benefits
Leads to plaque stabilization and regression
SPARCL trial - high dose atorvastatin was assoc w/ reduction in 5 yr risk of ischemic stroke
Adverse reactions: statin myosisitis and drug related rash, monitor hepatic functions
Simvastatin and pravastatin most favorable in pient tolerability
CREST trial goal of LDL<70 in those w/ DM
Antihypertensives - Answer Initiate when SBP>140 or DBP>90
Restarting these medication in the days following stroke is assoc w/ less stroke recurrence as well as less
incidence of other secondary cardiac endpoints -- typically 2 wks of stroke
Life's Simple 7 - Answer AHA aggregated score ranging from 0-14 (risk profile)
,Smoking, HTN, BMI, Physical Activity, Diet, Total Cholesterol and Glycemic Control
Score is graded for each category a 0 (poor), 1 (intermediate) and 2 (Ideal)
Antiplatelets - Answer ASA - before through and after carotid endarterectomy or stenting
DAPT - for symptomatic disease (ASA 81-325mg + clopidogrel 75mg daily) before and for a min of 30
days after stenting
Lowering A1C - Answer Reduction in stroke risk with A1c<7.0
Carotid endarterectomy (CEA) - Answer surgical procedure to remove blockage from the ICA with goal
of reducing risk of stroke
Meant for those w/ >=70% stenosis, no benefit for <50%
if a pt presents w/ symptoms a CEA should be scheduled w/in 1-2 wks or asap
If patient has bilateral stenosis, the symptomatic side should be operated on first, followed by the other
side in 1-2 weeks ( most severe lesion is prioritized )
Carotid artery stenting (CAS) - Answer There is a greater risk for patients treated with stenting and
there hasn't been a consensus stating that CAS is better than CEA
for plaques located at higher surgically inaccessible areas, stenting is appropriate
CEA not for those >70
CREST study suggests that older patients have an increased combined stroke and death rates in
comparison to younger patients
, 84 y/o w/ HX of DM and CHF that is refractory to medical treatment. Duplex study suggests 50% to 75%
right carotid stenosis. Which treatment is most appropriate? - Answer Medical management - her CHF
is refractery, asymptomatic stenosis has a less margin of benefit for CEA, CAS is not indicated for her age
Which of the following does *NOT* need to be instituted for a patient following carotid endarterectomy
- Answer Coumadin to target an INR of 2-3 (you do not have to start a patient on coumadin)
For which of the following patients is a left carotid endarterectomy most indicated? - Answer A 70 y/o
man with transient loss of vision in the left eye that recovered at 20 mins, and he has 75% left carotid
stenosis
Low probability of ischemia (descriptive words) - Answer Sharp
Fleeting
Shifting
Pleuritic
Positional
EKG for ACS - Answer Should be done w/in 10 mins of arrival
EKG findings for STEMI - Answer ST segment elevation
New LBBB
Winter Sign
Transient ST segment elevation
Posterior MI - Answer - ST depression V1,V2, V3
15-20% of STEMIs
Horizontal ST depression
Tall, brouad R waves (>30ms)
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