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
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