Mukherjee_Interventional Cardiology Board Review, 4e

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Interventional Cardiology Board Review

metformin 1,000 mg twice daily, metoprolol tar trate 50 mg twice daily, and ramipril 10 mg daily. A fasting lipid panel reveals total cholesterol 178 mg/dL, HDL-C 37 mg/dL, LDL-C 111 mg/dL, and triglycerides 148 mg/dL. Which lipid-lowering therapy is most appropriate to add at discharge? A. Evolocumab B. Ezetimibe C. Icosapent ethyl D. Inclisiran pain that occurred at rest. The ECG reveals ST de pressions in leads II, III, and aVF. Serial cardiac troponin I values are collected upon presentation and every 6 hours following and include 0.02, 0.123, and 0.957 ng/mL. A fasting lipid panel re veals total cholesterol 223 mg/dL, HDL-C 55 mg/ dL, LDL-C 70 mg/dL, and triglycerides 489 mg/dL, and a hemoglobin A1C is 10.1%. Which antihyper lipidemic therapy is best to initiate at this time? 7.24 A 68-year-old male with no PMH is admitted to the hospital with acute-onset, substernal chest 7.25 A 38-year-old woman is admitted to the ICU af ter an out-of-hospital cardiac arrest secondary to ventricular fibrillation. The patient is mechanically ventilated and receiving fentanyl and midazolam for analgesia and sedation. She is receiving tar geted temperature management, but shivering persists despite therapy with acetaminophen and buspirone. Cisatracurium is to be administered to control shivering. Which statement is TRUE regard ing analgesia and sedation during cisatracurium use? A. Deep sedation is required prior to cisatracu rium administration B. Light sedation is required prior to cisatracu rium administration C. Cisatracurium has analgesic and sedative properties D. Fentanyl and midazolam should be discon tinued after cisatracurium initiation 7.26 A 45-year-old woman is in the cardiac ICU with cardiogenic shock secondary to acute decom pensated heart failure. The patient was intubated on day 1 of the hospitalization and has received analgesia and sedation with fentanyl and propo fol, respectively, since the initiation of mechani cal ventilation. Dobutamine was initiated at 5 A. Atorvastatin 80 mg daily B. Rosuvastatin 10 mg daily C. Icosapent ethyl 2 g twice daily D. Fenofibrate 45 mg daily

µg/kg/min upon admission, and the infusion rate was decreased to 2.5 µg/kg/min by day 2 of the hospitalization. Mean arterial pressure and CO declined on day 3, necessitating up-titration of dobutamine to 10 µg/kg/min and initiation of epinephrine. On day 4, while the patient is receiving dobutamine, epinephrine, and norepi nephrine for hemodynamic support, laboratory data reveal a worsening lactic acidosis, rhabdo myolysis, and renal failure. Which medication could be causing the worsening clinical status of the patient? A. Fentanyl B. Epinephrine C. Propofol D. Dobutamine the patient becomes hypoxic and requires me chanical ventilation to maintain adequate arterial oxygenation. Current vitals include BP 102/74 mm Hg, HR 94 bpm, RR 25 bpm, and Sa o 2 86% on BiPAP with F io 2 60%. Relevant laboratory param eters include serum potassium 5.7 mEq/L, creati nine 1.6 mg/dL, AST 48 IU/L, and ALT 55 IU/L. The patient is administered fentanyl for analgesia. Which induction agent and neuromuscular block ing agent are most appropriate to facilitate rapid sequence intubation in this patient? A. Etomidate, succinylcholine B. Etomidate, rocuronium C. Ketamine, succinylcholine D. Propofol, rocuronium 7.28 A 63-year-old female with a history of nonisch emic cardiomyopathy is admitted to the cardiac ICU in cardiogenic shock secondary to severe mitral regurgitation. The patient is mechanically ventilated with an F io 2 40% and positive end–­ expiratory pressure (PEEP) of 10 cm H 2 O and maintaining an Sa o 2 of 98%. Relevant medications include milrinone 0.25 µg/kg/min intravenously, furosemide 15 mg/h intravenously, fentanyl 100 mg/h intravenously, and midazolam 4 mg/h in travenously. A Richmond Agitation Sedation Scale (RASS) score has been consistently recorded at − 3, and the Critical-Care Pain Observation Tool (CPOT) is 0. Which strategy is best to manage 7.27 A 49-year-old man is transported to the ED with a STEMI. While in the cardiac catheterization lab,

analgesia and sedation in this patient? A. Decrease fentanyl infusion rate B. Increase fentanyl infusion rate C. Decrease midazolam infusion rate D. Maintain midazolam infusion rate

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