Acute Coronary Syndrome

Question 1

new-onset chest pain suspected to be of cardiac ischemic origin?

Answer 1

Acute Coronary Syndrome

Question 2

NBSIM when ACS is suspected?

Answer 2

Obtain ECG

(& Troponin/ give ASPIRIN)

Question 3

STEMI-ACS patients require immediate ____ therapy with percutaneous coronary intervention (PCI) or fibrinolytic therapy.

Answer 3

revascularization

Question 4

All ACS patients receive ____ therapy and initially anticoagulation.

Answer 4

dual antiplatelet

Question 5

NSTEMI
Ischemia affects the inner layer of the heart ( _____ infarction)

Answer 5

subendocardial

Question 6

STEMI
Ischemia affects the full thickness of the myocardium
( _____ infarction)

Answer 6

transmural

Question 7

ischemic symptoms (angina at rest) without infarction

Answer 7

Unstable Angina

Question 8

ECG STEMI findings
ST elevations (in two contiguous leads)
or
new _____ with strong clinical suspicion of myocardial ischemia

Answer 8

left bundle branch block

(Leads: I, V1, V6)

Question 9

Patient presents with Chest pain.
What other findings (3) suggest cardiac catheterization is the NBSIM?

Answer 9

unstable hemodynamics
acute heart failure
STEMI

Question 10

Once STEMI (or cardiac cath) is ruled out by ECG,
what is the NBSIM for ACS (NSTEMI or UA)?

Answer 10

Start antiplatelet therapy and anticoagulation.
- Aspirin
- Clopidogrel
- Anticoagulation with UF-Heparin (Lovenox) , Enoxaparin, bivalirudin, or fondaparinux

Question 11

Once anti-platelet and anticoagulation therapy is started, what other adjunctive medical therapy for ACS might be needed.

Answer 11

Beta Blocker (Blood Pressure)
Nitroglycerin (Angina)
Morphine (Analgesia)
Supplemental oxygen as needed (SpO2 < 90% or Dyspnea)
Statin (secondary prevention)

Consider ACE-I

Question 12

Ischemic ECG changes + normal Troponin during Angina episode

Answer 12

Unstable Angina

(repeat troponin 3-6hr later & serial ECGs)