Cards 3 Flashcards

1
Q

According to Framingham, in order, what are the risk factors

A
Hypercholesterolaemia
Smokingcurrent
Psychosocial stressors
DM
Hypertension
Abdominal obesity 

If stop smoking, risk does return to baseline after 2-5 years

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2
Q

Cut offs for premature coronary disease

A

male 45

female 55

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3
Q

Young person with heart block and no risk factors think…

A

sarcoid

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4
Q

Treat cardiac sarcoid

A

Steroids might halt progression

ICD to prevent SCD

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5
Q

Most sensitive and most specific tests for cardiac sarcoid

A

PET most sensitive

CMR most specific

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6
Q

Cardiac failure and periorbital purpura… think

A

AL amyloidosis

Dont really get raccoon eyes and macroglossia in other types
Also look for hepatomegaly disproportionate to the degree of heart failure

Amyloid heart- at risk of strokes because of AV dissociation even in the absence of AF

Cardiac faillure… diuretics but nor ACE, beta or calcium ch use

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7
Q

LV thickening in amyloid,,,, what happens to the ECG voltage?

A

Reduces

unlike LHV from ischaemia

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8
Q

What does CMR show in amyloid?

A

diffuse subendocardial heterogeneous pattern of increased signal on delayed contrast enhanced inversion recovery T1-weighted images

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9
Q

What does CMR show in sarcoid?

A

delayed enhancement, which may be either mid-wall or transmural

nodular mid-wall hyperintense foci on black blood T2-weighted imaging

areas of focal myocardial thickening

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10
Q

What is the process for in stent thrombosis vs re stenosis

A

Re stenosis gradual narrowing that presents usually as angina pain over 3-12 months post stent

Due to neointimal hyperplasia

In stent thrombosis is abrupt thrombus in previously good stent causing large MI or death. BAD prognosis - doesnt matter where in vascular tree. Usually in first 4 weeks

Due to non endothelialisation of stent

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11
Q

Late stent thrombosis- where is the risk

A

Late stent thrombosis means in stent thrombosis after the first month
More common with DES because of delayed endothelialisation with DES

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12
Q

Benefit of DES?

A

REstenosis rate reduced

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13
Q

How is Clopidogrel metabolised?

A

CYP2C19

Smoking ENHANCES the antiplatelet effect of clopidogrel

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14
Q

5 surgeries you cannot do on DAPT

A
intracranial
spinal
plastic reconstructive
TURP 
Extraocular
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15
Q

When, for PCI, would you choose Clopidogrel over Ticagrelor

A

prior haemorrhagic stroke
active bleeding
bleeding diathesis
thrombocytopaenia

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16
Q

NSTEMI undergoing PCI, what is the preference with GPIIbIIIa?

A

Use bivalirudin in pref to heparin
If use bivalirudin, do not use a IIbIIIa inhibitor
If heparin used and clop/tic/pras–>use eptifibatide or abcix/eptifibatide after angio

17
Q

If know having fibrinolysis, what APT would you give in STEMI?

A

aspirin and clopidogrel (not tic/pras)

18
Q

If having STEMI and PCI, what APT to give?

A

aspirin and pras/ticag
but not pras/ticag if active bleeding
not pras if ever stroke

Only give GP2b3a agent if no DAPT given pre angio