acute coronary syndrome

Question 1

what are acute coronary syndromes

Answer 1

spectrum of clinical syndromes char. by ischemia

Question 2

2 types of ACS

Answer 2

1. unstable angina
2. MI
   - STEMI
   - non-STE MI

Question 3

def. unstable angina

Answer 3

CLINICAL SYNDROME char. by new or worsening coronary ischemia

Question 4

def. MI

Answer 4

myocardial necrosis due to cor. art. occlusion

Question 5

what does a Q wave indicate

Answer 5

Q waves tend to imply more loss of myocardium

Question 6

** central mech of ACS

Answer 6

plaque rupture

Question 7

when is plaque rupture more common

Answer 7

soft plaques with thin caps

- areas of positive remodeling

Question 8

what happens when platelets exposed to collagen

Answer 8

1. platelet activations
2. thrombus formation
3. may have coronary spasm

Question 9

** what does acute ST elevation mean

Answer 9

occlusive thrombus

Question 10

2 options for non-ST eleveation

Answer 10

1. non STEMI

2. unstable angina

Question 11

what can help on Hx

Answer 11

chest pain or angina equivalent
- unstable pattern
> 20 mins suggest infarct

Question 12

4 bad Sx for unstable angina

Answer 12

1. new onset
2. accelerated angina
3. rest angina
4. post-MI

Question 13

use of Phx

Answer 13

not specific for ACS

- more for complications

Question 14

5 possible ECG signs and what they mean

Answer 14

unstable angina/non-STEMI
1. normal
2. T inversion
3. ST depression
STEMI
4. ST elevation
5. new LBBB

Question 15

what do different leads tell you about locations

Answer 15

v1-v4 - anterior wall - LAD
2,3,aVF - inferior wall - RCA
v5-v6 - lateral wall - circumflex

Question 16

what are cardiac enzymes (2)

Answer 16

1. creatine kinase
2. troponin
   reasonably specific for MI
   elevated within 4-6 hours

Question 17

what are high sens. troponin assays

Answer 17

• ultra-hjigh sens., but at loss of spec.

- stable CAD 11%

Question 18

what is relationship with enzymes

Answer 18

unstable angina is a CLIN SYNROME

• can have without enzymes
• may have worse angina due to anemia, CO

Question 19

3 helpful therapies for Sx

Answer 19

1. rest
2. O2
3. pain control
   - nitro
   - morphine

Question 20

*** 5 ways to help survival

Answer 20

1. thrombus - heparin
2. platelets - ASA/clopidegril
3. B-blockers
4. CAD - statins, ACEi
5. education

Question 21

use of angiography/revasc

Answer 21

• improve prog.

- treat refractory Sx

Question 22

what is tool to assess prog

Answer 22

TIMI

Question 23

7 parts of TIMI **

Answer 23

1. age >65
2. 3 CAD risks
3. known CAD
4. ASA use before
5. Angina x2
6. ST-changes
7. high enzymes

Question 24

what is STEMI

Answer 24

= occlusion

- 90% will be infarcted withing 3 hours

Question 25

Hx for STEMI

Answer 25

angina>30mins

• dyspnea
• diaphoresis
• N/V

Question 26

Phx for STEMI

Answer 26

• sweating
• tachy
• S3, S4, murmur of mitral regurg
• finding of heart failure

Question 27

3 important mimics of MI and why important

Answer 27

1. PE
2. pericarditits - NO HEPARIN
3. aortic dissection - NO HEP

Question 28

what is seen in ECG

Answer 28

ST elev in 2 leads
- 1mm in limbs
- 2mm in precordial
New LBBB is equivalent to STelevation

Question 29

complications of MI

Answer 29

• tachyarrhymia
• brady arrhtmia
• LV failure
• rupture
• pericardidits
• RV failure
• stroke

Question 30

** main goal in STEMI therapy

Answer 30

reperfusion

Question 31

2 options to reperfuse

Answer 31

1. pharma
   - TPA
2. angio
   - most reliable

Question 32

5 aspects for post MI prog, and 2 most important

Answer 32

1. age*
2. LV funct*
3. resdiual coronoary disease
4. vent. arrythmia
5. comorbid disease