12 - Acute Coronary Syndromes and Stable Angina

Question 1

A 62 yo man reports 6 mo of chest discomfort on fast walking. His symptoms occur every time he walks 500 feet and beyond, are associated with SOB and are relieved after few min of rest. What is your most likely clinical diagnosis?
A.Unstable angina
B.Acute coronary syndrome
C.Chronic Stable angina
D.Printzmetal’sangina
E.Pericarditis
F.Aortic dissection
G.Pulmonary embolism

Answer 1

c

Question 2

A 30 yo woman reports sudden onset of sharp chest pain, increasing with deep inspiration and lying in the supine position, and relieved by sitting up. What is your most likely clinical diagnosis?
A.Unstable angina
B.Acute coronary syndrome
C.Chronic Stable angina
D.Printzmetal’s angina
E.Pericarditis 
F.Aortic dissection
G.Pulmonary embolism

Answer 2

e

Question 3

pathophys of chronic stable angina

Answer 3

stable plaque causing ischemia upon exertion. usually symptomatic when vessel is at least 70% occluded

Question 4

4 types of acute coronary syndrome

Answer 4

unstable angina
non-st elevation MI
st elevation MI
sudden cardiac death

Question 5

how long before sustained unstable angina becomes an MI?

Answer 5

15-20 min

Question 6

most reliable biomarker for MI

Answer 6

troponin

Question 7

what is the pathophys difference between MI w/ or w/o ST elevation?

Answer 7

w/o - partially occlusive event - 90-99% usually

w/ - complete blockage

Question 8

difference in initial tx of MI w/ or w/o ST elevation

Answer 8

w/o - early invasive strategy + medical tx

w/ - acute reperfusion therapy (immediate cath or fibrinolytic therapy) + medical tx

Question 9

where does angina usually radiate to?

Answer 9

L arm and jaw

Question 10

medical tx for acute coronary syndromes

Answer 10

antiplatelet: aspirin + (oral ADP antag like clopidogrel OR IV glycoprotein 2b/3a inhib)
anticoag: heparin of some form
anti-ischemic - beta blockers + nitrates (or CaCBs)