Acute Coronary Syndromes

Question 1

What EKG findings are associated with Unstable Angina and NSTEMI

Answer 1

ST Depression or T wave inversion

Question 2

How to distinguish Unstable Angina and NSTEMI

Answer 2

NSTEMI will have raised troponin levels

Question 3

TIMI Risk factors for acute coronary syndromes

Answer 3

Age (Over 65)
ST deviation on admission EKG
Prior Coronary Stenosis
2+ Anginal Episodes in the last 24 hours
Elevated Cardiac Markers
Use of Aspirin that week

Question 4

Indicators of a High Risk patient that should be sent directly to the Cath lab

Answer 4

Accelerating tempo of ischemic symptoms (shocked heart)
Ongoing Rest Pain
Pulmonary Edema
New/Worsening Murmur, S3
Hypotension, Tachy/Brady
Over 75yo
BBB
Troponin Levels

Question 5

Indicators of a Low Risk patient with ACS

Answer 5

No prolonged rest pain, moderate/high likelihood of CAD
Normal EKG during chest discomfort
Normal Cardiac Markers

Question 6

What should ST rises in all leads make you think of

Answer 6

Pericarditis

Question 7

Which is the greater indication of likely post hospitalization MI – Troponin or CAD

Answer 7

CAD

Mostly both

Question 8

Which EKG finding is most associated with risk of death/MI within 30 days

Answer 8

ST depression

Question 9

Which EKG finding is most associated with risk of death/MI in the hospital

Answer 9

ST elevation

Question 10

Who gets Oxygen?

Answer 10

In CHF, Cyanosis, or hypoxemia

Don’t give normally – can be harmful if you overload

Question 11

Medical therapy associated with ACS

Answer 11

MONA
Beta Blockers
Clopodigrel/Prasurgral/Trcagrelor
Unfractionated or Low MW Heparin
GP IIbIIIa Inhibitors

Question 12

Nitrates are contraindicated when…

Answer 12

Phosphodiesterases (Viagra) – Huge Drop in BP

RV Infarction

Question 13

Clinical signs of a R Ventricular Infarction

Answer 13

Hypotension
JVD
Clear Lungs
Check for Inf. ST elevation

Question 14

Which ACS patients should get beta blockers

Answer 14

All of them unless…

Hypotension, Severe Bronchospasm, Bradycardia (heart Block), Suspected coronary spasm (Prinzmetal/Cocaine)

Question 15

Aspirin reduced mortality by approximately ___% when given in a ____mg dose

Answer 15

50

81-325

Question 16

Common substitute for aspirin

Answer 16

Clopidogrel

Question 17

Timing of Clopidogrel is typically…

Answer 17

Pretreat prior to identification of the coronary anatomy

Continue one year or longer in high risk patients

Question 18

Name three GIIbIIIa Inhibitors

Answer 18

Abciximab (REOPRO)
Intregrilin (Eptifibitide)
Tirofiban

Question 19

When are invasive procedures preferred?

Answer 19

Recurrent Ischemia
CHF
Cardiogenic Shock
Within 6 months of PCI 
Previosu CABG

Question 20

In hospital early interventions

Answer 20

Early control of diabetes and cholesterol

Question 21

Problems with platelets in diabetes

Answer 21

Reduced membrane fluidity
Altered Ca and Mg homeostasis
Increased Arachadonic acid metabolism
More TXA2, Less NO, Prostacyclin
Enhanced expression of activation-dependent adhesions