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ACS Flashcards

1
Q

To call STEMI ST segment elevation should persist more than

A

20 mts

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2
Q

The normal MI due to plaque rupture we see is Type

A

1

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3
Q

In TMT ST depression in V1 indicates

A

Lcx disease-100% specific (but low sensitivity)

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4
Q

CK MB assays to avoid Macrokinase

A

Mass assays avoid detection of Macrokinase . Usually used is activity assay

If CK MB is > 20% of total CPK Suspect Macrokinase

Chronic skeletal muscle disease like DERMATOMYOSITIS/POLYMYOSITIS CK MB fraction may be as high as 50%

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5
Q

MC side effect of Ticagrelor

A

Dyspnea- More than 10%

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6
Q

RV is supplied by a single coronary artery and flow in diastole is ____%

A

50% in Diastole

In LV 90% flow occurs in Diastole

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7
Q

Stage 3 ECG change in Acute pericarditis

A

Diffuse T inversions :: usually after ST has become isoelectric

Stage 4 :is normal ECG

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8
Q

Stage 2 ECG change in acute pericarditis

A

Seen in First week

Normalization of ST and PR segments

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9
Q

ST elevation pattern in acute pericarditis

A

Diffuse ST elevation

ST depression in V1and aVR

PR elevation in aVR

PR depression in other limb leads and left chest leads ( esp V5& 6)

PR& ST change in opposite directions

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10
Q

Treatment of peri infarct pericarditis

A

Avoid using NSAID for 7-10 days

Then Aspirin 650-1000mg TID for 1-2 weeks

Colchicine may be given..

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11
Q

When to stop anticoagulation in PIP

A

If effusion more than 1 cm or if effusion increases 3 mm or more may consider stopping anticoagulation

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12
Q

M guard stent is

A

Stent with a micronet to prevent distal embolisation

In thrombotic lesions

Higher restenosis rates

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13
Q

Dose of tenecteplase in acute MI

A

30-50 mg over 5 sec

<60kg– 30 mg
>90 kg–50 mg

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14
Q

Stent thrombosis mortality rate

A

Upto 40%

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15
Q

Clinical and diagnostic picture of acute MI was first described in

A

1910

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16
Q

LV function doesn’t normalize in……% of patients after coronary reperfusion

A

30%

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17
Q

Re perfusion injury is responsible for ….% of infarct size

A

50%

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18
Q

Microvascular obstruction occurs in …..% of patients after PAMI

A

40%

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19
Q

Precordial Electrography was first described in

A

1944

Wilson and Rosenbaum

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20
Q

Introduction of enzymes into clinical practice was in

A

1955

by La Due

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21
Q

…..% of hospital deaths in first 72 hours is due to arrhythmias

A

70%

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22
Q

Intensive monitoring for AMI was first started in …… to prevent arrhythmic deaths

A

1962

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23
Q

Benefit of streptokinase in opening coronaries were first documented in

A

1976 by Chazov

Though streptokinase was used from 1950s the results were inconsistent

With intracoronary STK

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24
Q

First angioplasty was done in

A

1977 by Gruntzig

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25
Q

Stunned myocardium was first demonstrated in

A

1980 in dogs

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26
Q

Hibernating myocardium was first described in

A

1978

due c/c ischemia

In stunned myocardium blood flow is normal but in hibernating it is reduced

Both are viable myocardium

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27
Q

With coronary re perfusion in AMI … of area at risk is saved

A

50%

The rest will be scar

But strategies to reduce reperfusion will reduce the scar to 25% from the 50%

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28
Q

Factor Leiden V is

A

Type of Factor V which is inactivated less efficiently by Protein C

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29
Q

Inherited thrombophilias means

A

Factor V Leiden- most common
ProteinC,S,AT-III def
Prothrombin gene mutation

Total 5 inherited thrombophilias

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30
Q

Arterial thrombosis and inherited thrombophilias relation

A

Testing is NOT justified as they principally cause only Venous thrombosis

Further review there may be some association

Uptodate

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31
Q

MINOCA

A

MI with No Obstructive Coronary Atherosclerosis (<50% stenosis)

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32
Q

The 3 main antiphospholipid antibodies are

A
  1. aCL-anticardiolipin
  2. LA- lupus Anticoagulant
  3. Anti Beta 2 Glycoprotein antibody

aCLAB GP

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33
Q

The concept of microvascular obstruction was first posited in

A

1980

34
Q

Canakinumab is

A

IL 1-beta monoclonal Ab- a cytokine in inflammatory pathway

Used in CANTOS study.Reduced hscrp, cardiac events and Cancer without reducing cholesterol

35
Q

COMPASS trial is

A

Rivaroxaban in Stable CAD and PAD along with Aspirin

36
Q

Studies which showed LDL reduction below 70 in STEMI is useful

A

IMPROVE-IT , FOURIER

37
Q

Study suggesting to give Cangrelor in STEMI if P2Y12 inhibitors are not given

A

CHAMPION

38
Q

Study suggesting Tica for 36 months in STEMI

A

PEGASUS-TIMI 54

39
Q

Study which showed routine use of deferred stenting not useful in STEMI

A

DANAMI -DEFER

40
Q

When to switch to potent P2Y12 inhibitors after fibrinolysis

A

After 48 hrs Expert opinion

ESC 2017

41
Q

Role of routine revasc of Asymptomatic CAS 70-99% before CABG

A

Not indicated

42
Q

The clock for the 90 minute target to treat with PCI in STEMI starts at

A

The time of ECG diagnosis of STEMI

43
Q

In ESC DTB has been replaced with

A

FMC- first medical contact.—

44
Q

If fibrinolysis is planned for STEMI it should be given within

A

10 mts.
ESC 2017

Before it was 30 mts in 2012

45
Q

Deferred Stenting is

A

Open the Artery and wait for 48 hours to implant stent

In setting of primary PCI. ( Open the vessel with minimum manipulation and wait)

Not recommended.ESC2017

46
Q

Cut off for administering Oxygen therapy in STEMI

A

<90%
ESC 2017
Before it was 95%

47
Q

LBBB And RBBB is given equal consideration for URGENT CAG when Pt is having ischemic symptoms-as per

A

ESC 2017

48
Q

MINOCA forms—

A

14%

49
Q

Complete revasc recommendations in 2012 and 2017 ESC difference

A

2012-Not recommended
2017- To be considered at index procedure or before discharge

But CULPRIT-PCI trial which came later in 2017 showed it is not the correct strategy 😃😃🤣🤣😂🤣🤣

50
Q

hSTroponin levels -limit of detection by Roche diagnostic

A

Below 5ng/L not detected

99th percentile is 14 ng/L ie 0.014ng/ml in routine Trop units

51
Q

Study which showed immediate multivessel PCI is not useful in shock

A

CULPRIT-SHOCK 2017

Came at a time when ESCs new recommendations where for complete revasc!!!🤣🤣

52
Q

A trial which showed DCB non inferior to DES in Stent restenosis

A

DARE 2017 Used a paclitaxel coated balloon

53
Q

Infarct related artery in IWMI with ST elevation in III>II and ST depression in I, aVL

A

Prox/Mid RCA

54
Q

Infarct related artery in IWMI with ST elevation inII>III and ST depression in V1-3 (OR )ST elevation in I And aVL

A

LCx
or
Distal occlusion of a dominant RCA

Absence of ST depression in V1-3 has high negative predictive value for LCx

55
Q

Infarct related artery in IWMI with ST elevation in V1 and V4R

A

Prox RCA

56
Q

ECG findings in LAD occlusion proximal to first septal

A

complete RBBB, ST elevation in V1>2.5mm, ST elevation in aVR,ST depression in V5

57
Q

Infarct related artery if Q only in V4-6

A

LAD distal to S1

58
Q

IRA if Q in aVL

A

LAD prox to D1

ST depression inaVL- LAD distal to D1

59
Q

AWMI with inferior ST depression and ST elevation in aVL

A

LAD proximal to S1 and D1

If ST depression is absent lesion will be more distal

60
Q

ST elevation in aVR >or equal to V1 suggests

A

LMCA occlusion

61
Q

T wave changes in early STEMI

A

Tall and Broad based T waves

62
Q

Wellens syndrome is deeply inverted or biphasic T waves in

A

V2 /3 suggestive of critical LAD stenosis
May extend from V1-6

Type A - biphasic T
Type B- inverted T( first A then becomes B)

63
Q

AHA guidelines For thrombolysis in non PCI Hospital

A

Anticipated FMC to device time if > 2 hours give thrombolysis

64
Q

Tenecteplase is incompatible with

A

Dextrose solution

Flush IV lines with Saline if dextrose was used before

65
Q

STEMI in Hospital mortality change from 1997 to 2016

A

9.8 to 5.5% in men and 18.3 to 6.9 in females

NSTEMI corresponding rates are 7 to 2% and 11 to 4%

ESC 2017

66
Q

Studies supporting complete revasc in STEMI

A

PRAMI and CvLPRIT.

2017

67
Q

Cut off for Oxygen administration in ACS

A

<90% saturation. ( it was 95% before ESC 2017)

68
Q

MINOCA forms ——% of all MI

A

14%

69
Q

First LARGE scale randomized Trial of O2 therapy in suspected MI

A

2017 DETO2X-AMI

70
Q

Pts with symptoms s/o AMI account for ———% of EMS consultations

A

10%

ESC 2017

71
Q

ESC 2017 Guidelines for NSTEMI fast diagnosis

A

0/1 hour algorithm with Hs Troponin ( still u can miss 0.2-0.4%)

Around 30% will be false positives

Previous was 0/3 hour

72
Q

Percentage of AMI or ACS missed

A

2-10%

2005 JAMA

73
Q

The immediate life threatening causes of chest pain other than MI

A

Tension PnTx, PE, Dissection

74
Q

Sensitivity of the initial ECG in diagnosing AMI

A

20-60%

2005 JAMA

75
Q

Duration of classical angina pectoris according to classical teaching is

A

2-10 mts

76
Q

MI pain vs Aortic Dissection pain

A

MI pain- Crescendo pattern—ie maximum intensity after several minutes

Dissection- Maximal intensity at onset. Worst pain in life

77
Q

Pericardial pain is reduced by

A

Leaning forward

78
Q

Classical teaching on NTG response in MI and Esophageal disease

A

CAD- pain relieved in less than 5 mts

Esophageal- Takes more than 10 mts

79
Q

Likelihood ratio of Stabbing, pleuritic, positional or palpatory chest pain for ACS

A

0.2-0.3- means less likely.

Radiation to shoulder or arm- Likelihood ratio is 4

80
Q

If cardiac hs-Troponin changes

A

20%.

> 20% is likely ACS

Article from net

Cardio (36 decks)

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