Learning Cardiology

Background: We don't know the optimum mode of therapy for patients with stable ischemic heart disease along with moderate to severe myocardial ischemia on non-invasive stress testing. Routine early invasive therapy was compared with optimal medical therapy in this trial. Study design: Patients: Stable ischemic heart disease with moderate to severe ischemia on stress testing. All patients underwent CT coronary angiogram prior to inclusion in the trial to rule out significant LM disease. Exclusion: - LM stenosis >50% (on CT coronary angiogram) - Recent MI - LVEF < 35% - Unacceptable angina at baseline - NYHA class III and IV heart failure - Prior PCI or CABG within last one year Groups: Routine invasive therapy (n = 2588) vs initial optimal medical therapy (n= 2591) Interventions in both groups: - Routine invasive group: Patients underwent angiography followed by PCI or CABG as per the anatomy. - Medical therapy group: All patients were put on initial medi

Q. A 46 years old patient presented to you with history of chest pain for 3 hours duration. Initial ECG done at primary centre showed ST elevation in inferior leads which have completely resolved now. Patient is pain free at present. His vitals and clinical examination are completely normal. What should be the next appropriate strategy? A. Discharge the patient since clinical examination is normal and patient does not have any chest pain B. Observe him for at least 24 hours for recurrence of chest pain and then ask to follow in cardiology clinic C. Arrange early coronary angiography preferably within 24 hours D. Get the cardiac biomarkers done and if normal, discharge the patient to follow up in cardiology OPD Answer:  C. Arrange early coronary angiography preferably within 24 hours

Q. Which of the following is true regarding therapy in ACS? A. Oxygen should be given to all patients B. Nitrates can be used safely in RV MI C. Oral beta blockers are recommended in all ACS patients unless contraindicated D. Calcium channel blockers are absolutely contraindicated in ACS Answer: C. Oral beta blockers are recommended in all ACS patients unless contraindicated