CAD Screening

Question 1

What are the four USPSTF criteria for when screening is valuable?

Answer 1

• Disease:
  
  • Is common and serious
  • Has a prolonged asymptomatic phase
• Test:
  
  • Has few false-positives
  • Leads to an improvement in health outcomes

Question 2

What are the characteristics of a screening test which provide value?

Answer 2

• low false-positive rate
• use must lead to improved clinical outcomes

Question 3

What is an Impella?

What are the effects?

Answer 3

• Continuous axial flow device that pumps blood from the LV into the ascending aorta
• Effects:
  
  • unloads the LV
  • increases CO
  • reduces myocardial O2 demand

Question 4

Describe the different types of Impella?

Answer 4

• Impella 2.5
  
  • 12 Fr device implanted percutaneously
  • provides a maximal flow of 2.5 L/min
• Impella CP
  
  • 14-Fr device implanted percutaneously
  • provides a maximal flow of 3-4 L/min
• Impella 5.0
  
  • 21-Fr device that requires surgical cut-down
  • provides maximal flow of 5 L/min

Question 5

What are the two criteria that must be fulfilled to obtain CMS coverage of a VAD used as a BTT?

Answer 5

• Patient is approved and listed as a candidate for heart transplantation by a Medicare-approved heart transplant center
• Implanting site, if different than the Medicare-approved transplant center, must receive written permission from the Medicare-approved heart transplant center under which the patient is listed prior to implantation of the LVAD

Question 6

What are the two criteria that must be fulfilled to obtain CMS coverage of a VAD used as a DT?

Answer 6

• NYHA functional class IV symptoms in patients ineligible for heart transplantation
• Failure to respond to OMT for at least 45 of the last 60 days or
• Balloon pump-dependent for 7 days
• IV inotrope-dependent for 14 days
• LVEF < 25%
• Functional limitation with a peak oxygen consupmtion < 14 ml/kg/min

Question 7

What is the appropriate patient to perform CCTA in?

Why is this test good for this patient population?

Answer 7

• Symptomatic patients
• Low-intermediate pre-test probability (risk)
• high sensitivity and negative predictive value

Question 8

What is the goal of high-intensity statin therapy?

Answer 8

LDL-C reduction of at least 50%

Question 9

Define ACS

Answer 9

• a collection of clinical conditions that include acute myocardial ischemia and/or myocardial infarction
• secondary to an abrupt reduction in coronary blood flow or a mismatch in myocardial oxygen supply and demand

Question 10

What are the types of ACS?

Answer 10

• STEMI
• NSTEMI
• UA

Question 11

What is the pathophysiology of plaque rupture in ACS?

Answer 11

• acute disruption (or “rupture”) of a form of plaque that is biologically quite distinct form the more benign stable plaque
• Vulnerable plaque = thin-capped fibroatheroma (TCFA)
  
  • thought to be the culprit in most forms of ACS

Question 12

What did the PLATO trial show?

Answer 12

In NSTEM-ACS, Ticagrelor was assocaited with less CV mortality than Clopidogrel

Question 13

What EKG finding in RV MI / IMI is associated with higher mortality rate?

Answer 13

ST-elevation in V4R