Secondary Myocardial Ischemia Quiz

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Questions and Answers

Which of the following can cause cardiac troponin elevation without being directly related to myocardial ischemia?

  • Aortic dissection
  • Hypertrophic cardiomyopathy
  • Cardiac contusion (correct)
  • Severe pulmonary embolism

What type of heart condition can trigger troponin elevation due to secondary myocardial ischemia (MI type 2)?

  • Coronary vasculitis (correct)
  • Mitral valve prolapse
  • Pericarditis
  • Atrial fibrillation

Which of the following conditions is associated with troponin elevations due to damage not related to myocardial ischemia?

  • Severe burns affecting > 30% of body surface (correct)
  • Pulmonary hypertension
  • Acute pancreatitis
  • Hypertension

Which of these is NOT a cause of troponin elevation in the absence of overt ischemic heart disease?

<p>Myocardial infarction (D)</p> Signup and view all the answers

Which of these is NOT a condition associated with elevated cardiac troponin levels due to damage related to secondary myocardial ischemia?

<p>Acute coronary syndrome (C)</p> Signup and view all the answers

What is the recommended dosage of Varenicline on days 1-3?

<p>0.5 mg once daily (A)</p> Signup and view all the answers

When should Varenicline be taken in relation to food?

<p>With a light snack (D)</p> Signup and view all the answers

What is the recommended starting date for Varenicline?

<p>1-2 weeks before the quit date (D)</p> Signup and view all the answers

Which of the following is a precaution for Varenicline?

<p>Lactating women (A)</p> Signup and view all the answers

What is a common side effect of Varenicline?

<p>Nausea (D)</p> Signup and view all the answers

What is the recommended dosage of Varenicline for the remainder of the treatment?

<p>1 mg twice daily (B)</p> Signup and view all the answers

According to the PRECISE-DAPT score, what is the recommended dosage of prasugrel for patients undergoing stent implantation?

<p>60mg orally then 180mg orally then 10mg a day (A)</p> Signup and view all the answers

What is the recommended dosage adjustment for Varenicline in patients with renal impairment?

<p>Decrease the dosage (C)</p> Signup and view all the answers

What is a potential side effect of Varenicline related to sleep?

<p>Insomnia (C)</p> Signup and view all the answers

Which of the following antiplatelet agents is a cyclopentyl-triazolopyrimidine?

<p>Ticagrelor (B)</p> Signup and view all the answers

Which of the following is NOT a recommended dosage adjustment for clopidogrel in patients with chronic kidney disease (CKD)?

<p>Smokers with time-to-first cigarette (TTFC) of 30 minutes or less may receive a higher dose of clopidogrel. (C)</p> Signup and view all the answers

What is the recommended starting dose of clopidogrel for smokers with a time-to-first cigarette (TTFC) of 30 minutes or less?

<p>21mg (D)</p> Signup and view all the answers

Which of the following is a relevant resource for calculating the PRECISE-DAPT score?

<p><a href="http://www.precisedaptscore.com/predapt/webcalculator.html">www.precisedaptscore.com/predapt/webcalculator.html</a> (A)</p> Signup and view all the answers

What is the purpose of the PRECISE-DAPT score?

<p>To predict bleeding complications in patients undergoing stent implantation and subsequent dual antiplatelet therapy. (D)</p> Signup and view all the answers

According to the table, which antiplatelet agent is NOT recommended for patients with stage 5 CKD (eGFR <15 mL/min/1.73m2)?

<p>Prasugrel (A), Ticagrelor (B)</p> Signup and view all the answers

The article cited in the content is published in which reputable medical journal?

<p>The Lancet (C)</p> Signup and view all the answers

According to the PRECISE-DAPT score, what is the bleeding score threshold for a 1-year bleeding risk of >4.15%?

<p>≥36 (C)</p> Signup and view all the answers

Based on the PRECISE-DAPT score table, what is the approximate 1-year bleeding risk for a patient with a bleeding score of 15?

<p>0.88% (D)</p> Signup and view all the answers

What is the approximate 1-year bleeding risk associated with a bleeding score of 5?

<p>0.42% (B)</p> Signup and view all the answers

Based on the table, which of the following factors does NOT contribute to the bleeding score?

<p>Platelet count (B)</p> Signup and view all the answers

A patient with a creatinine clearance of 50 mL/min has a bleeding score of 15. Based on these data, what is the approximated 1-year bleeding risk?

<p>0.88% (A)</p> Signup and view all the answers

What is the highest bleeding score that corresponds to a 1-year bleeding risk of less than 1%?

<p>10 (C)</p> Signup and view all the answers

According to the table, what is the approximate 1-year bleeding risk for a patient with a bleeding score of 25?

<p>3.85% (B)</p> Signup and view all the answers

A patient has a bleeding score of 30. What is the approximate 1-year bleeding risk?

<p>3.85% (B)</p> Signup and view all the answers

Patients with a creatinine clearance of 60 mL/min and a haemoglobin level of 11.5 g/dL fall within which bleeding score range?

<p>11.0-11.5 (C)</p> Signup and view all the answers

A patient has a bleeding score of 10 and a haemoglobin level of 12 g/dL. What is the approximate 1-year bleeding risk?

<p>1.38% (A)</p> Signup and view all the answers

What is the threshold for a major or minor TIMI bleeding score in the PRECISE-DAPT model?

<blockquote> <p>5 (C)</p> </blockquote> Signup and view all the answers

What is the approximate 1-year bleeding risk for a patient with a haemoglobin level of 10 g/dL and white blood cell count of 16 x10^3 cells per µL, given the bleeding score is 15?

<p>0.88% (D)</p> Signup and view all the answers

If a patient has a creatinine clearance of 80 ml/min, what is the approximated age range associated with a bleeding score of 22?

<p>60-70 years (D)</p> Signup and view all the answers

What is the approximate 1-year bleeding risk for a patient with a bleeding score of 25 if they have a history of previous bleed?

<p>3.85% (B)</p> Signup and view all the answers

According to the PRECISE-DAPT score, what is the approximate 1-year bleeding risk for a patient with a bleeding score of 10?

<p>1.38% (C)</p> Signup and view all the answers

According to the HEART SCORE, a patient with a history of significant ST segment depression on ECG, age > 45 - < 65 years, and 1 or 2 risk factors would have a score of:

<p>5 (D)</p> Signup and view all the answers

Which of the following conditions is not considered a risk factor for coronary artery disease in the HEART SCORE?

<p>History of previous stroke (C)</p> Signup and view all the answers

A patient with a history of slightly suspicious symptoms, a normal ECG, is ≤ 45 years old, and has no known risk factors would have a HEART SCORE of:

<p>0 (A)</p> Signup and view all the answers

A patient with moderately suspicious symptoms, non-specific repolarization disturbances on ECG, age ≥ 65 years, and > 3 risk factors would have a HEART SCORE of:

<p>6 (B)</p> Signup and view all the answers

A patient whose troponin levels are > 1 - < 3 x normal, but has a normal ECG, is ≤ 45 years old, and has no known risk factors would have a HEART SCORE of:

<p>1 (C)</p> Signup and view all the answers

What is the highest possible HEART SCORE based on the information provided in the Appendix?

<p>8 (C)</p> Signup and view all the answers

Which of these factors carries the most weight in determining a patient's HEART SCORE?

<p>Risk factors (B)</p> Signup and view all the answers

The HEART SCORE is a tool used for:

<p>Assessing the risk of someone developing a heart attack (B)</p> Signup and view all the answers

What is the maximum number of risk factors for Coronary Artery Disease (CAD) that can contribute to a TIMI Risk Score of 1?

<p>3 (C)</p> Signup and view all the answers

Which of the following is NOT a variable used in calculating the TIMI Risk Score?

<p>History of coronary revascularization (D)</p> Signup and view all the answers

A patient presents with chest pain and has a TIMI risk score of 4. What category does this patient fall into?

<p>Moderate Risk (A)</p> Signup and view all the answers

What is the percentage of patients with a TIMI Risk Score of 2 who experience all-cause mortality, new or recurrent MI, or severe recurrent ischemia requiring urgent revascularization within 14 days?

<p>8.3% (A)</p> Signup and view all the answers

Which of the following would NOT contribute to a higher TIMI Risk Score?

<p>A history of a stroke (D)</p> Signup and view all the answers

What is the primary difference between the original HEART score and the Modified HEART score mentioned in the text?

<p>The Modified HEART score uses a different type of troponin. (D)</p> Signup and view all the answers

What category is a patient with a TIMI score of 7 placed in?

<p>High Risk (C)</p> Signup and view all the answers

What condition would lead to a TIMI score of 1 if it were the only factor present in the patient?

<p>Age 65 years or older (A), Known CAD (coronary stenosis of ≥ 50%) (B), Use of aspirin in prior 7 days (C), At least 3 risk factors for CAD (D)</p> Signup and view all the answers

Flashcards

Myocardial Ischemia Type 2

Damage to the heart muscle due to factors other than coronary artery blockage.

Cardiac Contusion

Bruising of the heart muscle, often occurring after trauma.

Cardiotoxic Agents

Substances that can damage the heart, such as certain chemotherapy drugs and carbon monoxide.

Rhabdomyolysis with Cardiac Involvement

A condition where damaged skeletal muscle releases toxins that can affect the heart.

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Apical Ballooning Syndrome

A condition characterized by temporary weakening of the heart muscle, often induced by stress.

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HEART Score

A scoring system used to evaluate the likelihood of non-ST elevation myocardial infarction.

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Highly suspicious history

A history indicating a high likelihood of myocardial infarction, scored as 2.

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Moderately suspicious history

A history suggesting a moderate likelihood of myocardial infarction, scored as 1.

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ECG significance

A measure of electrical activity changes in the heart, where significant ST depression scores 2.

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Age risk factor

Age scoring in HEART Score where ≥ 65 years scores 2, indicating higher risk.

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Risk factors

Factors such as diabetes, smoking, and hypertension considered for heart attack risk assessment.

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Troponins

Proteins released during heart injury; higher levels indicate greater risk, scoring up to 2.

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No known risk factors

When no significant risk factors are present, scoring 0 in the HEART Score.

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Varenicline

A smoking cessation drug used to help quit smoking.

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Dosage for Varenicline

Days 1-3: 0.5 mg once daily; Days 4-7: 0.5 mg twice daily; Day 8-end: 1 mg twice daily.

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Start date for Varenicline

Begin 1-2 weeks before the planned quitting date.

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Renal insufficiency

Condition where kidneys do not function adequately.

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Precautions for Varenicline

Should be used cautiously in those with renal insufficiency and lactating women.

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Common side effects of Varenicline

Nausea, headache, insomnia, and abnormal dreams are common.

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Nicotine replacement therapy

Methods like gum, patches, or lozenges to help quit smoking.

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Nicotine gum usage

A chewing gum designed to help manage nicotine cravings when quitting smoking.

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PRECISE-DAPT Score

A tool predicting bleeding complications in patients on dual antiplatelet therapy post-stent implantation.

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Clopidogrel

A thienopyridine antiplatelet used orally, frequently in cardiovascular conditions.

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Prasugrel

A thienopyridine antiplatelet agent taken orally, more potent than Clopidogrel.

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Ticagrelor

An oral antiplatelet from the cyclopentyl-triazolopyrimidine class, known for reversible action.

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Dosing in CKD

No dose adjustments required for Clopidogrel, Prasugrel, and Ticagrelor in CKD stages 3 to 5.

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Dual Antiplatelet Therapy

Combined use of two antiplatelet agents to prevent thrombotic events after stenting.

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Cyclopentyl-triazolopyrimidine

A chemical class that Ticagrelor belongs to, known for its unique molecular structure.

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Time-to-first cigarette (TTFC)

A measure indicating smoking dependence; affects antiplatelet dosing outcomes in smokers.

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Atherosclerotic disease

A condition characterized by the buildup of fats, cholesterol, and other substances in and on the artery walls.

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Coronary revascularization

A surgical procedure to restore blood flow to the heart muscle due to blocked arteries.

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TIMI Risk Score

A scoring system used to assess the risk of adverse cardiac events in patients with UA/NSTEMI.

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Low Risk category in TIMI

A TIMI score of 0-2 indicating a low risk of mortality or serious heart events.

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High Risk category in TIMI

A TIMI score of 5 or more indicating a high risk of mortality or serious heart events.

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Anginal episodes

Episodes of chest pain due to reduced blood flow to the heart muscle.

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Elevated serum cardiac biomarkers

Substances released into the blood when the heart is damaged, indicating potential heart problems.

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hs-cTn usage in heart score

High-sensitivity cardiac troponin is used in risk stratification to assess heart damage.

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NSTE-ACS

Non-ST Elevation Acute Coronary Syndrome, a type of heart condition.

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GRACE Score

A scoring system used to predict outcomes in acute coronary syndrome patients.

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Major Bleeding

Bleeding that leads to significant clinical consequences, often requiring intervention.

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Minor Bleeding

Bleeding that is less severe, often self-limited and may not require major intervention.

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CREATIVE Score

A score used to assess bleeding risk in patients on dual antiplatelet therapy.

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Hemoglobin Levels

Concentration of hemoglobin in blood, vital for transporting oxygen.

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White Blood Cell Count

Measure of the number of white blood cells in blood, often elevated in infections.

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Creatinine Clearance

A test to measure kidney function by assessing creatinine levels.

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Previous Bleed

History of bleeding events that affects current treatment risk assessment.

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Bleeding Score

A numerical value assigned to assess risk of bleeding in patients.

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Age Factor

Age is a significant predictor in cardiovascular risk assessments.

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ST Elevation

A finding on an ECG indicating significant heart injury or infarction.

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Acute Coronary Syndrome

A range of conditions resulting from reduced blood flow to the heart.

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Observation Study

A type of study where outcomes are observed without intervention.

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Study Notes

  • Tachy- or bradyarrhythmias
  • Aortic dissection and severe aortic valve disease
  • Hypo- or hypertension, such as hemorrhagic shock, or hypertensive emergencies
  • Acute and chronic heart failure without significant CAD
  • Hypertrophic cardiomyopathy
  • Coronary vasculitis, such as systemic lupus erythematosus or Kawasaki syndrome
  • Coronary endothelial dysfunction without significant CAD, such as cocaine abuse
  • Cardiac contusion
  • Cardiac incisions with surgery
  • Radiofrequency or cryoablation therapy
  • Rhabdomyolysis with cardiac involvement
  • Myocarditis
  • Cardiotoxic agents, such as anthracyclines, Herceptin, and carbon monoxide poisoning
  • Severe burns affecting more than 30% of body surface
  • Indeterminate or multifactorial group
  • Apical ballooning syndrome
  • Severe pulmonary embolism or pulmonary hypertension
  • Peripartum cardiomyopathy
  • Renal failure
  • Severe neurological disease, such as stroke or trauma
  • Infiltrative disease, such as amyloidosis or sarcoidosis
  • Extreme exertion
  • Sepsis
  • Acute respiratory failure
  • Frequent defibrillator shocks

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