ACS and Heart Failure

Question 1

What is the classic presentation for ACS?

Answer 1

Typical CP, epigastric feeling of fullness and gas, dyspnea, N/V, diaphoresis, fatigue, AMS

Question 2

What are the 3 classic components of angina?

Answer 2

Substernal CP or discomfort, provoked by exertion or emotional stress, relieved by rest and/or nitroglycerin

Question 3

What is typical angina?

Answer 3

has all 3 components of the diamond forrester criteria of CP

Question 4

What is atypical angina?

Answer 4

has 2 of the 3 components of the diamond forrester criteria of CP

Question 5

What is non-angina CP?

Answer 5

has <1 of the components of the diamond forrester criteria of CP

Question 6

What is unstable angina?

Answer 6

new onset angina, angina with exertion, angina at rest, or angina accelerating in frequency or severity; may or may not have ST depression and/or T wave inversions with normal cardiac enzymes

Question 7

What is NSTEMI?

Answer 7

Defined by ST segment depression and/or T wave inversions with abnormal cardiac enzymes

Question 8

What are the auscultatory cardiac findings of ACS?

Answer 8

Paradoxical splitting of S2 (LBBB), new mitral regurgitation murmur (holosystolic), papillary dysfunction/rupture, pericardial friction rub, distant S1 and S2, diminished pulses, delayed cap refill

Question 9

What is the classic presentation for HF?

Answer 9

DOE, fatigue, edema, orthopnea, JVD, rales, paroxysmal nocturnal dyspnea, dyspnea at rest, RUQ discomfort due to hepatic congestion (RHF)

Question 10

What PE findings significantly increase the likelihood of HF?

Answer 10

JVD, S3 heart sound and displaced apical impulse

Question 11

What will HFrEF show on an echo?

Answer 11

reduced LVEF, atrial and ventricular chamber dilation or hypertrophy, valvular dysfunction, pericardial pathology and elevated ventricular filling pressures

Question 12

What does TEE rule out?

Answer 12

intracardiac thrombi or infectious source of HF

Question 13

What does a stress echo/nuclear stress testing/cardiac CT rule out?

Answer 13

Ischemia as a precipitating cause for HF

Question 14

What does an cardiac MRI determine the etiology of?

Answer 14

cardiomyopathy by IDing the presence of inflammation, fibrosis, and infiltrative pathology

Question 15

Cardiopulmonary exercise testing is an important component in the determination of what?

Answer 15

candidacy for mechanical circulatory support and cardiac transplantation

Question 16

What is the management for ACS?

Answer 16

Aspirin, relief of ischemic pain, assessment of hemodynamic state, initiation of repercussion therapy with percutaneous coronary intervention or fibrinolysis, anti-thrombotic therapy to prevent rethrombosis, beta blocker to prevent recurrent ischemia and ventricular arrhythmias, ACEi, statin, dual anti platelet therapy

Question 17

How is ACS diagnosed?

Answer 17

ECG, cardiac biomarkers, invasive coronary angiography

Question 18

What is the treatment for a STEMI?

Answer 18

Initiate medical therapy with aspirin, beta blocker, nitrates, heparin and then either perform PCI or transfer to PCI capable facility (after performing thrombolytic theory)

Question 19

What does a TIMI score predict?

Answer 19

risk of 14 day death, recurrent MI or urgent revasculariziton

Question 20

What are the MCC of acute HF exacerbations?

Answer 20

myocardial ischemia or infarct and noncompliance

Question 21

What can be useful as a diagnostic marker for HF?

Answer 21

BNP

Question 22

What does tx for HF include?

Answer 22

oxygenation, correction of the underlying cause, relief of sx by preload and after load reduction, and possibly inotropic support

Question 23

What are the goals of HF tx?

Answer 23

improve sx, duration of life and prevention of hospitalization

Question 24

What is the tx for acute decompensated HF?

Answer 24

Monitor oxygen saturation, vital signs and cardiac rhythm; non-invasive ventilation unless respiratory failure; initiate diuretic therapy to relieve congestion/fluid overload; nitroprusside for after load reduction and IV dobutamine or milrinone for HRrEF

Question 25

What is the management for HFrEF?

Answer 25

Tx of underlying cause of HF, pharmacological therapy, conduction abnormalities (cardiac resynchronization therapy), monitor renal function and electrolytes

Question 26

What is the management for HFpEF?

Answer 26

Diuretics are the mainstay in the absence of HTN, ID and tx comorbidities

Question 27

What is the tx for cor pulmonale?

Answer 27

Maintain oxygen delivery to tissues, optimize volume status (diuretics, fluids and Na restriction), arrhythmia management, inotropes for low CO, activity restriction while symptomatic, palliative care

Question 28

What pt education should be provided to HF pts?

Answer 28

take meds as prescribed, follow action plan of sx, call doctor if you gain weight suddenly, cut down on salt, lose weight if you are overweight, stop smoking, avoid alcohol, be active