ACS/AMI I

Question 1

why do trops rise in NSTEMI?

Answer 1

distal embolization

Question 2

exact definition of typical angina

Answer 2

1. SSCP/discomfort
2. worse w/ exertion or stress
3. relieved by NTG or rest

Question 3

exact definition of atypical angina

Answer 3

chest pain with 2/3 characteristics of typical angina

SSCP/discomfort, worse w/ exertion or stress, relieved by NTG or rest

Question 4

name 4 anginal equivalents

Answer 4

dyspnea
Nausea
fatigue
faintness

Question 5

Classification system for MI

Answer 5

1- plaque rupture
2- supply/demand (spasm, HTN, arrhythmia, embolus)
3- SCA (no objective evidence)
4a- s/p PCI
4b- IST
5- s/p CABG

Question 6

are elderly (>75) more likely to have STEMI or NSTEMI?

Answer 6

NSTEMI

Question 7

who has higher risk of In-Hospital mortality (elderly or young)

Answer 7

elderly

Question 8

When choosing meds for elderly s/p ACS, what to watch out for?

Answer 8

calculate creatinine clearance

bleeding

Question 9

what are the two inflection point (in years) for closing of a SVG vs artery?

Answer 9

5 and 10 years

Question 10

which pt pop is at high risk for coronary artery dissection?

Answer 10

pregnant

Question 11

what are the two local vasoconstrictors released from activated platelets?

Answer 11

serotonin

thromboxane A2

Question 12

who gets oxygen is NSTEMI/UA?

Answer 12

when O2 sat<90%

Question 13

what med to discontinue in NSTEMI/UA?

Answer 13

NSAIDs

Question 14

TIMI risk score components

Answer 14

1. > 65yo
2. > 3 CAD risk factors
3. prior obs CAD 50%
4. ASA in last 7d
5. > 2 anginal events in 1d
6. ST deviation
7. high trop/CK

Question 15

TIMI score of what is low risk?

Answer 15

<3

Question 16

GRACE score components

Answer 16

age
resting HR
SBP
Cr
CHF (Killip)
cardiac arrest at admission
ST deviation
trop/CK

Question 17

what does GRACE score predict?

Answer 17

probability of in-hospital and 6 month mortality and MI

Question 18

in TIMI score, what are the markers of highest risk (regardless of other factors)? which is worse?

Answer 18

ST deviation

biomarkers- WORSE

Question 19

3 factos contributing to myocardial oxygen demand

Answer 19

HR
Contractility
Wall tension (SBP, Vol)

Question 20

Definition fo non-cardiac chest pain

Answer 20

Meets 1 or none of the angina criteria (SSCP/discomfort, worse w/ exertion or stress, relieved by NTG or rest)

Question 21

definition of New onset angina

Answer 21

< 2 mo’s, atleast CCS Class III (marked limitation with nl activity like 1-2 blocks or Flight of stairs).

Question 22

3 A’s of platelet activity

Answer 22

Adhesion, Activation, Aggregation

Question 23

in a patient with suspected unstable angina, what serial test is important to do in ER?

Answer 23

EKG

Question 24

how long after a pt has taken sildenafil or tadalafil do you wait until giving nitrates?

Answer 24

> 24h

Question 25

when is it recommended to give clopidogrel in UA/NSTEMI?

Answer 25

when pt is intolerant of ASA

Question 26

for pt’s with mild-mod CRI or DM and NSTEMI/UA, os conservative or early invasive strategy preferred?

Answer 26

invasive

Question 27

which trial showed “an early invasive strategy (36h) in NSTEMI, and may be beneficial in high risk patients?”

Answer 27

TIMACS