ACS

Question 1

A 53 year old male awakens in the morning with crushing chest pain that occasionally radiates into the neck and jaw. He has had these same symptoms before, but only in the morning. It doesn't bother him while working out or walking. 
This man mostly likely is suffering from
A. Unstable Angina
B. STEMI
C. Prinzmetal's Angina
D. None of the above

Answer 1

C. Prinzmetal’s Angina

This angina is the result of coronary artery spasms and is not brought on by exercise. It is most common among males 51-57.

Question 2

What are three additional names for Prinzmetal’s Angina?

Answer 2

Variant, Atypical, or Vasospastic.

Question 3

Define Unstable Angina

Answer 3

Discomfort that occurs when oxygen demand exceeds oxygen supply.

Question 4

What is the most important modifiable risk factor associated with Prinzmetal Angina?

Answer 4

Smoking

Question 5

Identify 3 symptoms of Prinzmetal’s Angina

Answer 5

Chest Pain: Under sternum, Squeezing, constricting, tightness, pressure or crushing. May radiate. Most often occurs at rest. Lasts 5-30 minutes. Relieved by NTG.

Question 6

What is the Gold standard for diagnosis of Prinzmetal’s Angina?

Answer 6

Coronary Angiography with injection of a provocative agent such as Ergonovine, methylergonovine, or acetylcholine.

Question 7

What medication is used to treat Prinzmetal’s Angina?

Answer 7

Calcium channel blockers.

Question 8

What are the top 4 modifiable risk factors associated with Unstable Angina?

Answer 8

Smoking, HTN, Obesity, and Hyperlipidemia.

Question 9

Name 4 unmodifiable risk factors of unstable angina

Answer 9

Sex > in males until around age 65.
Age: 55-60
Family History
Race: African American, esp. females.

Question 10

What diagnostics are used to identify Unstable Angina?

Answer 10

12-lead ECG showing T wave inversion and ST-Depression.
Also collect ABG’s, H&H, and Enzymes
Perform Echo

Question 11

How quickly should an echo be performed during Unstable Angina?

Answer 11

Within 60 minutes. If EF

Question 12

What is the recommended treatment for Unstable Angina?

Answer 12

• Oxygen
• Aspirin
• Nitrates
• Beta Blockers
• Calcium Chanel Blockers (Post Stent)
• Heparin
• GBA inhibitors.

Question 13

Name 3 contraindications to the administration of Aspirin in the setting of ACS.

Answer 13

• Hypersensitivity
• Active GI bleed
• Reactive airway disease (caution)