ACS and hyperlipidemia

Question 1

Common EKG finding for NSTEMI

Answer 1

T wave inversion or ST segment depression, but NOT ST segment elevation

Question 2

Management of NSTEMI

Answer 2

• Lower risk patients: ASA, P2Y12 inh, anticoag (heparin)

- higher risk patients: above plus cath lab

Question 3

What are the anterior EKG leads and what is the corresponding blood vessel?

Answer 3

Leads V1-V4

LAD

Question 4

What are the lateral EKG leads and what is the corresponding blood vessel?

Answer 4

Leads V5-V6

Circumflex

Question 5

What are the Inferior EKG leads and what is the corresponding blood vessel?

Answer 5

leads II, III, AVF

RCA

Question 6

What is the target time for reperfusion therapy in STEMI?

Answer 6

12 hours

• TPA if transport to PCI hospital will be > 12 hrs
• if time from first medical contact at non-PCI hospital to device time at PCI hospital is > 2 hours

Question 7

How long should you continue DAPT?

Answer 7

1. If stent placed for ACS - continue DAPT for 12 months then may stop P2Y12 inh but continue aspirin indefinitely
2. If stent placed for stable CAD - continue DAPT 6 mo after DES and 1 mo after bare metal stent
3. After CABG continue at least 1 year

Question 8

Which of the following medications improve survival post-MI?

• ACEI
• Beta blocker
• statin
• aspirin
• DAPT
• nitroglycerine
• CCB
• Digoxin

Answer 8

• ACEI –> survival
• Beta blocker –> survival
• statin –> survival
• aspirin –> survival
• DAPT –> survival
• nitroglycerine –> symptoms
• CCB–> symptoms
• Digoxin –> symptoms

Question 9

What is Sgarbossa criteria and how do you interpret the scores?

Answer 9

Sgarbossa Criteria: helps diagnosed MI when LBBB is present

- score of > 3 highly specific for ACS but much less sensitive

Question 10

Treatment of pericarditis

Answer 10

NSAIDs

Question 11

What are the four statin benefit groups?

Answer 11

1. ASCVD
2. primary elevation of LDL > 190 (usually familial)
3. Diabetes age 40-75 and LDL > 70
4. no ASCVD or DM, age 40-75, LDL >70 and estimated 10 year ASCVD risk > 7.5%

Question 12

How do you select statin intensity for the four statin benefit groups

Answer 12

ASCVD or LDL > 190 –> high intensity
DM, age 40-75 and LDL > 70 –> mod or high intensity
Other group –> moderate intensity

Question 13

What should you prescribe in a pt with high risk ASCVD and LDL > 70 despite maximum statins?

Answer 13

Consider adding ezetimibe

If that doesn’t work PSCK9 inhibitor

Question 14

What level of rise in CK should prompt discontinuation of statin?

Answer 14

Discontinue statin if CK more than 10 times upper limit of normal