ACS

Question 1

Where do the coronary arteries come from?

Answer 1

Ascending aorta

Question 2

Blockages of LCA lead to what?

Answer 2

CHF and left ventricle not pumping effectively

Question 3

Blockages of RCA lead to what?

Answer 3

Right sided heart failure

Bradyarrhythmia due to SA node not getting blood

Question 4

Left and right coronary veins drain their deoxygenated blood into what?

Answer 4

Coronary Sinus then to the Right atrium

Question 5

So what’s the issue about Oxygen rich blood demand and myocardium?

Answer 5

Myocardium requires up to 65% O2, which does not allow much room for compensation if there is a reduction in blood flow.

normal tissues only require roughly 25%

Question 6

What is Angina basically?

Answer 6

Chest pain caused by ischemia (myocardium isn’t getting enough O2)

Question 7

Hallmarks of Stable Angina?

Answer 7

Pain only on exertion

Relieved by rest

Question 8

Unstable Angina Hallmarks

Answer 8

Pain while resting

• Looks like NSTEMI
• Use cardiac markers to rule out MI

Question 9

What is Prinzmetal’s Angina?

Answer 9

Caused by coronary vasospasm without any CAD

Question 10

How can O2 delivery to the myocardium be increased?

Answer 10

Increase blood flow (Increase DBP or coronary dilation)

Decrease HR

Question 11

What’s causing increased myocardial O2 demand?

Answer 11

Ventricular hypertrophy
Increased HR
Increased contractions

Question 12

What falls under ACS?

Answer 12

Unstable Angina
NSTEMI
STEMI

Question 13

Which MI is partial thickness infarction?

Answer 13

NSTEMI

Question 14

Hallmark of NSTEMI?

Answer 14

Non-specific EKG or ST depression

Elevated Cardiac enzymes

Question 15

Hallmark of STEMI

Answer 15

Both ST elevation and Cardiac enzymes

Question 16

How can you tell the difference between a Prinzmetal Angina MI vs NSTEMI and STEMI?

Answer 16

Cardiac Catherization - no blockages in the coronary vessels

Will present with increased cardiac markers and ST elevations/depressions

Question 17

What is a suspicious cause of NSTEMI or STEMI for young individuals with no risk factors?

Answer 17

Cocaine use - causes severe vasoconstriction

Question 18

What’s your hallmarks for MI?

Answer 18

SUBSTERNAL CHEST PAIN
Elephant on your chest
Radiation
Pain at rest
New Heart Murmur
Mitral Regurg
S3 for LV - overload CHF

Levine’s sign

• Anxious
• Diaphoretic
• Clinched fist over chest

Question 19

Pulse will depend on location of infarction why?

Answer 19

RCA - SA lack of perfussion leads to bradycardia

LCA - tachy and CHF

Question 20

Labs for MI?

Answer 20

Troponin
CK-MB
EKG
Chest X-ray for CHF
Echo
Cardiac Catheterization

Question 21

Treatment for MI

Answer 21

PREVENT further cardiac damage
ABCs, Monitor, O2, IV

ONAM

• O2
• Nitro - 0.4mg sublingual q 5 min for angina
• Aspirin - 325mg chew
• Morphine - 4mg IV for unresponsive to nitro