Acute Coronary Syndrome

Question 1

What conditions are considered acute coronary syndrome?

Answer 1

Unstable angina, MI, STEMI, NSTEMI

Question 2

If pt presents with symptoms of ACS, what is the first thing to do?

Answer 2

12 lead EKG to look for ST elevations

Question 3

What do all STEMI pt require?

Answer 3

Reperfusion

Question 4

How is an acute MI diagnosed?

Answer 4

Evolution of biomarkers

Question 5

How does an MI result?

Answer 5

Most common is prolonged ischemia due to thrombus formation on a disrupted or eroded atherosclerotic plaque

Other reasons include cocaine, embolic occlusion, reduced blood flow, etc.

Question 6

Pt with acute MI can die from what?

Answer 6

VFib

Question 7

What are some clinical features of ACS?

Answer 7

Non traumatic chest pain

Sweating, N/V, weakness, SOB, anxiety, syncope

Question 8

The diagnostic difference between UA and NSTEMI

Answer 8

ST Depression on EKG & elevation in cardiac biomarkers

Question 9

What is the definitive diagnostic procedure for an MI?

Answer 9

Coronary angiogram

Question 10

Treatment of ACS

Answer 10

• IV fluids, oxygen, and nitro
• IV nitro if persistent ischemia, heart failure, HTN for first 48 hr
• BB in first 24hrs if no heart failure, heart block, bradycardia
• ACE/ARB if heart failure presence
• Statin initiated
• CCB for pt with contraindication for BB or nitrates

Question 11

Scoring systems for ACS

Answer 11

• TIMI

- GRACE

Question 12

Reperfusion for STEMI

Answer 12

• Asprin and clopidogrel
• Coronary angiogram and PerCutaneous Intervention
• Thrombolytic therapy

Question 13

Conservative treatment for UA and NSTEMI

Answer 13

• antiplatelet therapy (aspirin & clopidogrel)

- anticoagulant therapy (enoxaparin)