Acute Coronary Syndrome

Question 1

The other EKG finding (not ST elevation) that can indicate STEMI

Answer 1

New left bundle branch block

Question 2

Who is eligible for a PCI?

Answer 2

90 minutes from arrival at the hospital

OR

120 minutes from arrival at a non-PCI capable hospital and transfer to a PCI capable hospital

Question 3

Who is eligible for fibrinolysis?

Answer 3

Non-PCI eligible patients within 12 hours of symptom onset (The interval of hospital arrival to fibrinolysis initiation should be < 30 minutes)

OR

Non-PCI eligible patients with ongoing chest pain within 24 hours of symptom onset

Question 4

When to use a GPIIb/IIIa antagonist

Answer 4

Non-STEMI: In addition to aspirin and heparin (instead of clopidogrel)

STEMI: As an adjunctive therapy in patients undergoing angioplasty

Question 5

LBBB vs RBBB

Answer 5

Question 6

Management of acute mitral regurgitation and CHF secondary to papillary muscle rupture

Answer 6

1. Manage the MI
   
   • MONA BASH with careful use or avoidance of beta blockers
2. Reduce the fluid load
   
   • Furosemide
   • Positive pressure ventilation (noninvasive preferable)
3. Bridge to PCI, CABG, or open heart surgery to fix the papillary muscle
   
   • Aortic balloon pump or ventricular assist device
4. Improve the forward ejection fraction
   
   • IV nitroprusside (afterload reduction)
   • IV dobutamine (improved contractility)

Question 7

Management of cardiogenic shock

Answer 7

1. Fluid challenge
   
   • Perform only if no pulmonary edema is present
2. Positive inotrope
   
   • Dobutamine
   • Epinephrine (avoid in cardiac arrest)
   • Milrinone (best in RV dysfunction)
3. Vasopressor
   
   • Phenylephrine
   • Norepinephrine
   • Vasopresso (preferred in cardiac arrest due to epinephrine antagonism)
4. s

Question 8

Use of ___ for management of diabetes is contraindicated in patients with CHF

Answer 8

Use of thiazolidinediones for management of diabetes is contraindicated in patients with CHF