ACS review

Question 1

Old infarction shows up as

Answer 1

Pathologic Q waves

Question 2

Ischemia, ECG changes

Answer 2

ST depression; T-wave Inversion

Question 3

Acute infarction shows

Answer 3

ST Elevation

Question 4

Five medications that we should give

Answer 4

Beta Blockers; ACEI/ARBs; CCB; Anticoagulants; Statins

Question 5

If patient is in remote area, what should you consider if PCI facility not close?

Answer 5

tPA

Question 6

Morphine in ACS causes and decreases ____

Answer 6

Vasodilation ; afterload

Question 7

Nitrates decreases

Answer 7

Preload

Question 8

Beta blockers will

Answer 8

lowers sympathetic activity and oxygen demand of heart

Question 9

ACEI and ARBS

Answer 9

Decrease after load

Question 10

all ACS patients are going to SAABS

Answer 10

Statin; Aspirin, ACE/ARBs, betablocker

Question 11

Start with ACEI

Answer 11

Captopril

Question 12

Stress Test: recommended

Answer 12

known CADS, or unstable angina.

Question 13

MRI cardiac recommended: not enough evidence of cath lab.

Answer 13

Looking for aortic roots, arches issues.

Question 14

Cath recommended for

Answer 14

STEMI

Question 15

TIMI score: risk stratification for Cath lab

Answer 15

1. Greater than 65
2. HLD, HTN, family history of CAD
3. Known coronary stenosis >50%
4. ST segment deviation on ECG
5. AT least two angina episodes in prior 24 hours
6. use of aspirin 7 days prior
7. Elevated serum troponin of CK-MB

Question 16

Indications for CABG

Answer 16

Multivessel disease
2 vessel disease if >75% LAD stenosis especially with LVSD
3 vessel disease especially with LVSD
>50% left Main stenosis
Papillary muscle rupture, VSD, carcinogenic shock, life threatening arrhythmia.
Diabetics with multivessel disease.

Question 17

Post PCI

Answer 17

EKG, ECHO, trop trending down, monitor for vascular complications:hematomas, AKI, ARRHYTHMIAS post perfusion. pseudoaneurysms, vasavagalr reaction. Cardiac diet.
start beta blockers immediately