Order Primary Rescue and Facilitated Angioplasty

Order Primary Rescue and Facilitated Angioplasty
Order Primary Rescue and Facilitated Angioplasty
1 The currently accepted maximum medical contactto-balloon or door-to-balloon time for patients
with ST-segment elevation myocardial infarction
(STEMI) is:
(A) 30 minutes
(B) 60 minutes
(C) 90 minutes
(D) 120 minutes
(E) 360 minutes
2 A 76-year-old man presents with an acute anterior
wall myocardial infarction (MI). Emergent coronary angiography reveals a completely occluded
left anterior descending (LAD) artery with thrombolysis in myocardial infarction (TIMI) 0 flow
(see figure below) and a 70% to 80% stenosis
of the right coronary artery (RCA) with TIMI 3 flow (see figure above). Left ventriculogram
shows anterolateral hypokinesis. His heart rate is
88 and blood pressure (BP) is 127/78 with an
oxygen saturation of 98% on room air. Optimal
management of this patient will include:
(A) Bypass surgery because he has two-vessel disease
involving the LAD artery
(B) Percutaneous coronary intervention (PCI) of
the LAD artery only and consideration of PCI
of the RCA at a later date (staged PCI) or
noninvasive evaluation to assess RCA territory
ischemia postdischarge, and PCI if indicated
(C) PCI of the LAD and the RCA
(D) PCI of the LAD and measurement of fractional
flow reserve (FFR) of the RCA to assess
Primary, Rescue, and Facilitated Angioplasty 89
hemodymanic significance followed by PCI if
3 A 69-year-old man presents to the emergency room
of a community hospital without a PCI facility with
an acute ST-segment elevation anterior wall MI. He
is a tachycardiac and tachypneac with a heart rate of
112, BP of 76/43 and has rales in both the lung fields.
Optimal management of this patient includes:
(A) Immediate administration of full-dose fibrinolysis
(B) Immediate administration of half-dose fibrinolysis with full-dose abciximab
(C) Immediate administration of half-dose abciximab with full-dose fibrinolysis
(D) Arrangement for transfer to the nearest hospital
with PCI facility that is 70 minutes away
4 A 68-year-old woman presents to your office for
evaluation of chest discomfort she had the previous
evening. The discomfort lasted for approximately
30 to 40 minutes and subsequently resolved. Currently, she is pain free with a heart rate of 74 and
a BP of 118/71. Her lungs are clear to auscultation and you do not hear any significant murmurs
on cardiac exam. Electrocardiogram (EKG) reveals
evolving STEMI. On further questioning she states
discomfort started at approximately 7:00 pm last
evening and lasted till 7:45 pm or so. It is now
10:00 am the next morning. Appropriate management would include:
(A) Admission to the hospital and treatment
with aspirin, heparin, clopidogrel, statins, and
(B) Admission to the cardiac catheterization laboratory for emergent angiography with a goal of
primary PCI
(C) Administration of full-dose fibrinolysis, admission to hospital, and treatment with aspirin,
heparin, clopidogrel, statins, and β-blockers
(D) Administration of full-dose fibrinolytics and
then admission to the catheterization laboratory
for emergent angiography
5 Transfer of patients with STEMI to PCI-capable
center rather than immediate fibrinolysis should be
considered in all of the following situations, except:
(A) When fibrinolytic therapy is contraindicated or
(B) When cardiogenic shock ensues
(C) When the anticipated delay to PCI is 90 to 120
(D) When symptoms have been present for >2 to 3
6 In patients with STEMI, compared with fibrinolysis,
primary PCI lowers the odds of death by:
(A) 5%
(B) 10%
(C) 15%
(D) 20%
(E) 25%
7 The role of embolic protection devices in primary
PCI is best characterized as being:
(A) Strongly recommended for all patients undergoing primary PCI (Class I recommendation)
(B) Strongly recommended for primary PCI only in
patients with large thrombus burden (Class I
(C) Currently not recommended for primary PCI
(D) Recommended for patients with no reflow after
8 A 67-year-old man undergoes bypass surgery for
severe three-vessel coronary disease. Approximately
12 hours after the surgery he becomes short of breath
and has 3 mm ST elevation in the inferolateral leads.
The best management strategy at this time is:
(A) Conservative management without coronary
(B) Coronary angiography followed by catheterbased treatment strategy with subsequent PCI
(C) Coronary angiography followed by surgicalbased treatment strategy readmitting patients
to emergency redo-coronary artery bypass graft
(D) Coronary angiography followed by conservative
9 Predictors of 1-year mortality among 30-day survivors after primary PCI include all except:
(A) Age >70 years
(B) Any tachyarrhythmia during index hospitalization (defined as ventricular or supraventricular
tachycardia that required treatment)
(C) Weight <80 kg
(D) Number of diseased coronary arteries
(E) Left ventricular ejection fraction (LVEF)
(F) Female gender
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