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Old 09-04-2011
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Default cardiology quiz

High guys I'm doing cardiology, let us try this quiz

65 old male, over wt presented with chest pain & dyspnea on exertion, exercise stress test showed ST depression, total plasma cholesterol is 85 mg/dL, ejection fraction within the normal. Which of the following is the best to lower mortality?
  • Aspirin
  • TPA
  • Statin
  • ACE inhibitors
  • Exercise
  • Wt loss.
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Old 09-04-2011
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aspirin

acei , exercise and wt loss don't effect mortality.
aspirin and statin LOWER mortality...
since his cholestrol is within normal range...aspirin is all that is left

i hope that's the ans


i made a pneumonic for mortalty benefit in ischemic heart disease or acute coronary syndrome
following decrease mortality TPM for ACS temporary pace maker for acute coronary syndrome

Thrombolytic
Primary angioplasty/PCI
Metoprolol

Aspirin
Clopidogrel
Statin
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Last edited by busterbee; 09-04-2011 at 10:35 AM. Reason: ag2011 insisted for an explanation:)
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Old 09-04-2011
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Would you please busterbee, give some explanation.
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Old 09-04-2011
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in ur case pt pr with angina symptoms so for future mortality benefit we r keeping pt on ASPRIN, and theres no any other issue with this pt, there r also other method thru which we can reduce mortality benefit, remember one thing in cardiology if pt is presenting with chest pain exclude thru egc wheather theres ischemic changes r not if theres ischemic changes also instead of that 1st we have to give ASPRIN then thrombolytic, i hope u got it...
if im wrong plz correct me, its our learning phase
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Old 09-04-2011
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Guys you are good.
this is a summary:
The following lower mortality:
  • Aspirin, The best.
  • Beta Blockers.
  • TPA.
  • Angioplasty.
  • Clopidogrel if aspirin contraindicated(DONOT Use Ticlopidine associated with TTP & neutropenia)
  • Statin if LDL is high > 100.
  • ACE if EF is low.
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Old 09-04-2011
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Thanks ag2011n for starting the thread. I have also started cardiology recently....

I think the scenario is of stable angina more precisely Chronic Stable Angina.

Among all the therapies, the most significant mortality benefits have come form the use of Aspirin because it decreases the incidence of Acute MI. So all patients of ischemic heart disease are put on aspirin (if contraindicated Clopidogrel).

Regarding other option,
  1. TPA & PCI also reduces mortality but if done in a case of early acute MI.
  2. CABG also reduces mortality if done in case of triple vessel disease or DM + two vessel disease or involvement of LMCA.
  3. Statins if somebody has high LDL
  4. ACE if HTN or CHF
  5. Beta Blockers have proven mortality benefits by preventing reinfarction. But also indicated to pts of Angina & CHF as they dec. Myocardial oxygen demand.
  6. Quitting smoking if smoker.
  7. Exercise & weight reduction
A mnemonic to summarize treatment options;

A. Aspirin and Antianginal therapy
B. b-Blocker and Blood pressure
C. Cigarette smoking and Cholesterol
D. Diet and Diabetes
E. Education and Exercise
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Last edited by step1an; 09-04-2011 at 12:03 PM.
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Old 09-04-2011
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As usual you add a lot to every post. Thanks step1an
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