Cards cards 2

Question 1

What does LGE actually mean on MRI?

Answer 1

• GAD washes out more slowly from areas of fibrosis or acute cell necrosis
• can predict recovery of function after revascularisation
• good to look for sarcoid
• see subendocardial sparing in myocarditis and NON ISCHAEMIC causes
• in amylodosis diffuse LGE from subendocardium

Question 2

How many METs for ADLs?

Answer 2

5

Question 3

What meds to stop pre exercise test?

Answer 3

beta blocker one day

digoxin one week

Question 4

Sens and spec EST?

Answer 4

78% both

Question 5

Aim to achieve workload in EST?

Answer 5

220/210 minus pt age
over 9-12 minutes exercise

satisfactory if get to 85%
Remember pathological ST segs are horizontal or downslopint
Upsloping ok

Question 6

When to stop an EST>

Answer 6

Pt asks to
SEVERE chest pain, dizziness, or dyspnoea
Fall SBP more than 20
Rise in BP to Systolic over 300 or diastolic over 130
Ataxia

Remember that BP will normally go up with exercise, to about 235

ST depression more than 3mm
ST elevation over 1mm in a non Q wave lead
Frequent vent extrasystoles
new VT
New AF or SVT
development of new BBB
New heart block 2 or 3
Cardiac arrest!

Question 7

What is the most specific ECG sign on EST for ischaemia

Answer 7

Inversion of U wave

Question 8

How does dobutamine work as as stress agent? What about adenosine, dipyridamole, regadenoson?

Answer 8

Dob- increase myocardial oxygen demands and contractility

Others- induce regional hypoperfusion via coronary vasodilation

Question 9

Cannot do an EST if?

Answer 9

MI within 30 days
severe AS, symptomatic
Uncontrolled arrhythmia
decop heart failure
acute PE
aortic dissection

Interpretation limited if LBBB, LVH, WPW pattern, pacing- may choose exercise stress echo instead

Question 10

Compare sens and spec of exercise ECG, PET stress, stress echo, nuclear spect

Answer 10

SENS: pet stress, nuclear spect, stress echo, stress ECG

SPEC: stress echo, PET stress, ECG and nuclear spect

Question 11

Adenosine acts on

Answer 11

A2A receptors –>coronary artery vasodilation - if stenosis then there is relative flow heterogenicity introduced

can cause BRONCHOSPASM and AV block but short half life- avoid in uncontrolled asthma, heart block without pacemaker, sick sinus, critical AS

If get chest pain then not necessarily indicative of ischaemia

A1 receptors for the AV block side of things

Hold caffeine prior 12 hours

Question 12

If want to look for flow heterogeneity use…

If want to assess LV function use…

Answer 12

vasodilators
dobutamine (induce regional wall motion abn)

Question 13

Regadenoson acts on

Answer 13

A2A receptors–>coronary vasodilation

Aminiphylline if the antidote
Avoid in heart block
easy as can just chuck in as a bolus

Question 14

Dipyridamole acts on…

Answer 14

Indirectly vasodilates by INCREASING adenosine levels

Can bring on bronchospasm and rarely MI

Question 15

In LBBB choose vasodilator stress echo why?

Answer 15

Because in exercise stress the conduction delay can cause a false positive abnormality

Question 16

Dobutamine acts on…

Answer 16

beta1 beta2 alpha

Question 17

When can dobutamine be useful?

Answer 17

COPD, asthma, critical aortic stenosis

CAN GIVE where adenosine not ok

Question 18

Peak time of risk for contrast nephropathy?

Answer 18

3-5 days

Question 19

How do you manage a pseudoaneurysm post angio?

Answer 19

Ultrasound guided compression or best supportive care

If cannot get haemostasis or femoral neuropathy–>surgical management

Question 20

What should you do if you hear a 1/6-2/6 midsystolic murmur in asympromatic person?

Answer 20

Nothing else

Results of imaging unlikely to alter management

Question 21

See a cardiac tumour that is probably secondary, most likely to come from…
Tumour that is most likely to met to heart is…

Answer 21

breast or lung

lymphoma and melanoma

Question 22

If on ticagrelor, need to limit…

Answer 22

aspirin to 100mg or less per day (no benefit ticag if higher doses)
no more than 40mg atorvastatin (ticag increases dose)

Question 23

Which side effect do they make a fuss about with ticagrelor?

Answer 23

Dyspnoea and ventricular pauses

this is adenosine mediated

Question 24

What is the problem with tryin gto suck out clot during PCI?

Answer 24

Stroke risk double

Question 25

What is the difference between femoral and radial approach for PCI?

Answer 25

Less bleeding with radial

Question 26

Most sensitive test for aortic dissection

Answer 26

TOE!

CTA more practical though

Question 27

Risk per year in stent thrombosis

Answer 27

0.8 across board

Question 28

How long to defer non cardiac surgery post BMS

Answer 28

“At least 6 weeks and ideally 3 months”

Question 29

How long to defer non cardiac surgery post DES?

Answer 29

12 months

have to stop DAP 5 days to allow bleeding compl to be ok

If you HAVE to stop, and deemed high risk, should do op in a PCI facility, monitor in HDU post op, and may consider bridging anticoagulation with heparin/tirofiban pr heparin/eptifibitide (GP2b3as)

Question 30

?bridging anticoagulation

Answer 30

Guidelines say:

-low bleeding risk and mod-high risk in stent thrombosis then continue DAPT. Low risk bleed and low risk in stent thrombosis then just aspirin

• high risk bleeding and mod-high IST risk- stop DAP and cosider bridging therapy
• low risk IST then stop DAP