ACS!!

Question 1

TIMI Score - A

Answer 1

age greater than 65
aspirin use in last week
2 or more episodes of angina in past 24 hours

Question 2

TIMI Score - B

Answer 2

cardiac biomarkers

Question 3

TIMI Score - C

Answer 3

CAD risk factors (htn, hld, dm, smoker, family hx)

Question 4

TIMI Score - D

Answer 4

documented CAD with greater than 50% stenosis

Question 5

TIMI Score - E

Answer 5

EKG Changes

Question 6

What risk are we looking at w/ TIMI Score?

Answer 6

Risk of death/mi/urgent revasculariation in 14 d in pts with UA/NStEMI

Question 7

Risk and TIMI

Answer 7

low - 02, inter 3-4, high 5-7

Question 8

Family History of MI age

Answer 8

first degree relative
les than 55 for males
less than 65 for females

Question 9

PCI - time frame

Answer 9

90 min from first medical contact

Question 10

Thrombolytic therapy - time frame

Answer 10

30 minutes door to needle

Question 11

STEMI Protocol - first 5 minutes

Answer 11

O2, 12 lead

Question 12

STEMI Protocol - first 15 min

Answer 12

ASA 324 chewed
heparin 50u/kg IV
Plavix 600mg po

Question 13

Prasugrel contraindictions

Answer 13

stroke or TIA as it increases risk for cerebral hemorrhage

Question 14

ACS Medial treatment per Dr. Smyth

Answer 14

Aspirin 81.  
P2y12 antagonist - for at least year
Beta blockers - at least year
ACEI
Aldosterone blockers
statin

Question 15

ACEI if…

Answer 15

CHF, ef

Question 16

Aldosterone blockade if…

Answer 16

ACEI + EF

Question 17

Discharge and MI Risk Reduction - A

Answer 17

aspirin and anti-anginals

Question 18

Discharge and MI Risk Reduction - B

Answer 18

beta blockers and BP

Question 19

Discharge and MI Risk Reduction - C

Answer 19

cholesterol and cigarettes

Question 20

Discharge and MI Risk Reduction - D

Answer 20

diet and diabetes

Question 21

Discharge and MI Risk Reduction - E

Answer 21

exercise and education about smoking cessation

Question 22

Typical Angina

Answer 22

1) substernal chest discomfort w/ characteristic quality and duration that is
2) provoked by exertion or emotional stress
3) relieved by rest or NG

Question 23

Atypical angina

Answer 23

2 characteristics

Question 24

Noncardiac chest pain

Answer 24

1 or 0 characteristics

Question 25

Very Low risk and diagnosing IHD

Answer 25

risk reduction | no additional testing due to high false positives

Question 26

Low risk and diagnosing IHD

Answer 26

``` exercise test (High NPV) Coronary CTA/calcium score ```

Question 27

Intermediate risk and diagnosing IHD

Answer 27

exercise test plus or minus imaging (echo/nuc/mri) pharmagological + imaging coronary CTA

Question 28

High risk and diagnosing IHD

Answer 28

cardiac cath w/ coronary angiogram | no imaging due to high false neg

Question 29

Features that make MI less likely

Answer 29

pleuritic chest pain sharp or stabbing pain positional chest pain reproducible chest pain

Question 30

Early repolarization often has

Answer 30

J-point elevation | rapidly, up-sloping or normal ST segment

Question 31

Conditions that cause ST elevation

Answer 31

``` MI. Vasospasm, Pericardiatis, LV aneurysm after Mi Early repolarization LVH LBBB Hypothermia (prom J waves) Hyperkalemia (advanced) ```