ACS

Question 1

What are the 4 cardinal risk factors for CAD?

Answer 1

1. Elevated serum lipid level. Serum cholesterol level >5.0 mmol/L or a fasting triglyceride >3.7 mmol/L
2. Hypertension BP >130/80 mm Hg for diabetics
   3 Tobacco use
   4 Physical inactivity

Question 2

Describe reversible myocardial ischemia

Answer 2

Reversible; angina (chest pain), o2 demand is greater than o2 supply

Question 3

Describe clinical manifestations of chronic stable angina

Answer 3

ST segment depression
Pain lasting 3-5 minutes
Pain at rest

Precipitating factors: 
Physical exertion
Strong emotions
Tobacco use
Heavy meal 
Circadian rhythm: early morning

Question 4

Angina Decubitus

Answer 4

Chest pain that occurs only while lying down; relieved when standing

Question 5

Prinzmetal’s Angina

Answer 5

Varian Angina
Occurs at rest, during a spasm of the CA
Spasm may occur in the abscense of CAD
Spasm is cyclical at a usual time of day.
CCBlockers and/or nitrates to control angina

Question 6

What are some goals of drug therapy in CSA?

Answer 6

Decrease O2 demand or increase O2 supply
Short-acting nitrates
Long-acting nitrates
B-Adrenergic blockers
Calcium channel blockers of Bblockers are poorly tolerated
ACE inhibitors (antihypertensive)

Question 7

What do calcium channel blockers accomplish?

Answer 7

1. Systemic vasodilation with decreased SVR
2. Decreased myocardial contractility
3. Coronary Vasodilation

Question 8

What would a patient with a stent be given post-surgical? Why?

Answer 8

Stents are thrmbogenic. The patient would be given antiplatelet agents such as clopidogrel and aspirin until the intimal lining can grow over the stent.

Question 9

Acute Coronary Syndrome?

Answer 9

When ischemia is prolonged and not immediately reversible

• Unstable Angina
• Non-St segment-elevation myocardial infarction (NSTEMI)
• ST-segment elevation (STEMI)

Question 10

When does stable angina become acute coronary syndrome?

Answer 10

Deterioration of a once stable plaque that stimulatels platelet aggregation and local vasoconstriction with thrombus formation

Results in partial occlusion (UA or NSTEMI) OR Total occlusion of CA (STEMI)

Question 11

What are some signs and symptoms of an MI

Answer 11

Pain- chest pain, heaviness, epigastric pain etc.
Sympathetic nervious stimulation- release of glycogen, diaphoresis, vasoconstriction, ashen/clammy skin
Crackels
Initial high BP, HR, then low BP HR due to low CO
JVD
Fever/Inflammatory response

Question 12

Which two lab values are important after an MI?

Answer 12

Troponin and CK-MB tests

Enzymes are released from the dead cardiac cells

Question 13

What are some complications after an MI?

Answer 13

Dysrhythmias 
Cardiogenic shock
Papillary muscle dysfxn
Ventricular anerysm 
Acute pericarditis
Dressier syndrome

Question 14

What would an ECG reveal in someone with Unstable Angina or MI?

Answer 14

Changes in QRS complex, ST segment and T wave.

Distinguish between STEMI and NONSTEMI

Question 15

What is an emergent PCI? When is it given?

Answer 15

Balloon angioplasty plus drug eluting stenets, given within 90 mins of arrival at emergency room

Question 16

Contraindications for fibrinolytic therapy

Answer 16

Any prior intracranial hemorrhage
Known malignant intracranial neoplasm (primary or metastatic)
Ischemic stroke within 3 months EXCEPT acute ischemic stroke
within 3 hours
Suspected aortic dissection
Active bleeding or bleeding diathesis (excluding menses)
Head injury within the last 3 months

Question 17

Inclusion Criteria for fibrinolytic therapy

Answer 17

1) Chest pain typical of acute MI

Question 18

What is one concern with fribrinolytic therapy?

Answer 18

Re-occlusion of the artery. Site of thrombus is unstable and another clot may form.

Question 19

When is Coronary Revascularization indicated?

Answer 19

Bypass surgery (CABG) is indicated when medical management has not worked
The left coronary artery is damaged or when three vessels are damaged
Not a PCI candidate
Failed PCI