Acute Coronary Syndrome - QUIZ Flashcards
What is the definition of Myocardial Infarction Type 1?
Related to atherosclerotic plaque rupture, ulceration, fissuring, erosion, or dissection with intraluminal thrombus in one or more of the coronary arteries, leading to decreased myocardial blood flow or distal platelet emboli and thereby resulting in myocyte necrosis.
When the myocardium experiences a period of ischemia and then undergoes reperfusion, reperfusion injury may result in a period of depressed myocardial contractility that is termed myocardial stunning.
True or False?
True
The extraction of oxygen from the coronary blood that perfuses the heart is increased when the:
Ratio of coronary flow to myocardial oxygen consumption is decreased
Insufficient blood flow to the myocardium causes which of the following electrical changes?
Injury currents that produce ST segment changes in the electrocardiogram
If a region of the left main coronary artery becomes stenotic such that its diameter is reduced by 50%, how will this impact blood flow to the myocardium supplied by this artery?
Maximal coronary blood flow capacity will be reduced in the absence of collateralization
If a coronary vasodilator drug is administered when stenotic lesions are present in the left main coronary artery, and in the left anterior descending coronary artery just distal to the circumflex branch, which of the following may occur?
a) Decreased blood flow in the circumflex artery
b) Decreased blood flow in the left anterior descending artery
c) Increased pressure within the circumflex artery
d) Increased pressure within the left anterior descending artery
b) Decreased blood flow in the left anterior descending artery
Which patient(s) are most at risk for developing coronary artery disease?
Select ALL that apply.
a) A fit and previously healthy 24-year-old with a new cancer diagnosis.
b) An overweight 32-year-old with a 2 ppd smoking history.
c) A late 40’s female whose father died of MI at a young age.
d) A 30-year-old Type 1 diabetic.
b) An overweight 32-year-old with a 2 ppd smoking history.
c) A late 40’s female whose father died of MI at a young age.
d) A 30-year-old Type 1 diabetic.
Coronary artery dissection can happen spontaneously and is more common in women than men.
True or False?
True
A patient is 36 hours post myocardial infarction. The patient is starting to complain of chest pain when they lay flat or cough. You note on auscultation of the heart a grating, harsh sound. What complication is this patient mostly likely suffering from?
Pericarditis
After a myocardial infraction, at what time (approximately) do the neutrophils begin to congregate at the infarction site due to inflammation?
24 hours
Your patient has been on heparin for several days while awaiting transfer for angiography. Which of the following lab results is cause for concern?
a) Platelets 125,000
b) WBC 12.4
c) HGB 126
d) aPTT 68
a) Platelets 125,000
PCI has a lower bleeding risk than fibrinolytics. True or False?
True
Which of the following is NOT an absolute contraindication to thrombolytics?
a) Intracranial hemorrhage within 12 months.
b) Known structural vascular lesion
c) Pseudoaneurysm at femoral art-line insertion site
d) Advanced liver disease
d) Advanced liver disease
Which anti-platelet has the lowest risk of bleeding?
a) Ticagrelor
b) Clopidogrel
c) Prasugrel
b) Clopidogrel
Which of the following is NOT true of CABG?
a) It relieves angina and lowers mortality risk in ACS.
b) Vasculature from the heart is used to bypass the atherosclerotic lesion.
c) The procedure requires the heart to be stopped.
d) The procedure may be performed in addition to balloon angioplasty.
b) Vasculature from the heart is used to bypass the atherosclerotic lesion.
Decreased sympathetic activity, especially when coupled with increased endothelial production of the vasodilators nitric oxide and prostacyclin, can precipitate Prinzmetal’s angina. True or False?
False
Multiple fixed stenotic lesions can lead to a redistribution of flow within the major supply arteries of the heart under conditions of exercise or vasodilator therapy. As blood flow increases in one region of the coronary vascular network, blood flow can reciprocally decrease in another region leading to anginal pain. This condition is referred to as:
Vascular steal
Which of the following is most accurate regarding the physical examination findings associated with MI?
a) In patients with inferior wall MI with RV involvement, JVD is an indicator of failure of the right ventricle.
b) Hypotension excludes a diagnosis of MI.
c) Fever associated with MI typically occurs after the initial 48 hours and is correlated with decreased LV function.
d) A new mitral regurgitation murmur indicates the presence of a LBBB.
a) In patients with inferior wall MI with RV involvement, JVD is an indicator of failure of the right ventricle.
When patients come to the emergency department with atrial fibrillation, which of the following may be an indication of increased risk for MI among those who do not have a primary diagnosis of ST-segment elevation MI (STEMI) or non–ST-segment elevation MI (NSTEMI)?
a) ECG indicative of RVH
b) AF with RVR in the absence of elevated troponin
c) Dyspnea
d) Elevated troponin
d) Elevated troponin
Which of the following is accurate about the etiology of ACS?
a) Most cases of ACS occur from disruption of a previously non-severe lesion
b) Decreased blood glucose levels are risk factors for a major adverse cardiac event in patients with suspected ACS
c) ACS without elevation in demand typically excludes thrombosis or plaque hemorrhage
d) Takotsubo syndrome only occurs in the presence of clinical coronary artery disease
a) Most cases of ACS occur from disruption of a previously non-severe lesion
NSTEMI’s do not result in transmural infarction and are therefore not candidates for emergent PCI. True or False?
False
