Acute Coronary Syndromes

Question 1

What is rest angina?

Answer 1

Occurring at rest and prolonged, >20 min

Question 2

What is increasing angina?

Answer 2

Previously diagnosed that has become more frequent, has a longer duration, or is lower in threshold, limiting ability to walk 1-2 block, or climb 1 flight of stairs

Question 3

What are the 3 kinds of unstable angina?

Answer 3

New, rest, increasing (changing)

Question 4

What is required before you give nitro?

Answer 4

EKG

Question 5

What is angina chest pain due to?

Answer 5

Ischemia

Question 6

What leads are inferior?

Answer 6

II, III, aVf

Question 7

If the RCA is affected what can you not give?

Answer 7

Nitro

Question 8

What determines coronary artery blood flow?

Answer 8

Duration of diastolic relaxation and peripheral vascular resistance

Question 9

What are some things that classically precipitate angina?

Answer 9

Exercise, stress, and a cold environment

Question 10

What is associated w/ non-classic ACS presentations?

Answer 10

DM, advanced age, female

Question 11

What are the traditional risk factors for factors for CAD?

Answer 11

1. HTN
2. DM
3. Tobacco
4. Fam Hx
5. Hypercholesteroemia

Question 12

What are bradycardia rhythms more common with?

Answer 12

Inferior wall myocardial ischemia

Question 13

What sound is present in 15-20% of AMI and may indicate a failing heart myocardium?

Answer 13

S3 (passive filling of an overly compliant LV creates the sound)

Question 14

What does rales indicate?

Answer 14

LV dysfunction and L sided heart failure

Question 15

JVD, hepatojugular reflex and peripheral edema suggest what on examination?

Answer 15

Right sided heart failure

Question 16

What is the diagnosis of NSTEMI depend on in the setting of symptoms?

Answer 16

Abnormal evlevaton of cardiac biomarkers

Question 17

What is the TIMI score? thrombosis in myocardial infarction

Answer 17

Stratifies the 14 day risk of mortality, w/ new or recurrent AMI or severe recurrent ischemia requiring urgent revasularization

Question 18

What is the TIMI?

Answer 18

1. Age 65 y/older
2. 3 or more traditional risk factor
3. Prior coronary stenosis 50%
4. ST segment deviation
5. 2 or more animal events in 24 hrs
6. Aspirin use w/in 7d prior
7. Elevated cardiac markers

Question 19

What is the single best test to identify AMI?

Answer 19

ECG

Question 20

How long do you have to obtain and interpret the initial 12 lead ECG tracing w/ patient presenting w/ symptoms of myocardial ischemia?

Answer 20

10 min

Question 21

What is the general definition of a STEMI?

Answer 21

ST elevations of 1mm or more in at least 2 contiguous leads w/ reciprocal changes

Question 22

What are the two ECGs that you are required to have?

Answer 22

The first and then pain free

Question 23

Anteroseptal

Answer 23

V1, V2, maybe V3

Question 24

Anterior

Answer 24

V1, V2, V3, V4

Question 25

Anterolateral

Answer 25

V1-V6, I, and aVL

Question 26

Lateral

Answer 26

I and aVL

Question 27

Inferior

Answer 27

II, III, aVF

Question 28

True posterior

Answer 28

Initial R waves in V1 and V2>.04 s and R/S ratio?=1

Question 29

Inferolateral

Answer 29

II, III, aVF, V5, V6

Question 30

Right ventricular

Answer 30

II, III, aVF and ST in right sided V4

Question 31

How do you identify AMI in the setting of a LBBB?

Answer 31

1. ST- elevation 1mm or greater and concordant (in the same direction as the main deflection) w/ the QRS complex 2. ST segment depression of 1 mm or more in leads V1, V2, V3 3. ST segment elevation of 5 mm or greater and discordant ( in the opposite direction) with the QRS

Question 32

Should unstable angina have positive cardiac markers?

Answer 32

No!

Question 33

What is the diagnostic criteria for acute myocardial infarction using serum markers?

Answer 33

Gradual rise and fall of cTn w/ a maximum value above the 99th percentile combined w/ any of the following 1. Symptoms of ischemia 2. Acute ECG changes 3. Wall motion abnormality 4. Loss of viable myocardium

Question 34

What are the absolute contraindications to STEMI fibrinolytic therapy?

Answer 34

1. Prior intracranial hemorrhage 2. structural cerebral vascular lesion, 3. intracranial neoplasm, 4. ischemic stroke w/in 3 months, 5. active internal bleeding, 6. suspected aortic dissection/ pericarditis

Question 35

What is the dysrthmia that he said that can occur as a result of ACS?

Answer 35

A fib

Question 36

What can occur in 1-5 days post infarction?

Answer 36

Ventricular free wall rupture

Question 37

What are the signs and symptoms of ventricular free wall rupture?

Answer 37

Tearing pain or sudden severe pain, w/ hypotension, tachycardia, and onset of confusion, increased neck veins, decreased heart sounds, pulses paradoxus

Question 38

What is associated w/ a new holosystolic murmur after MI and how do you see it?

Answer 38

Doppler echo,interventricular septum rupture

Question 39

2-4 days after transmural AMI, discomfort w/ deep respiration’s relieved by sitting fwd?

Answer 39

Pericarditis

Question 40

What is the treatment for pericarditis?

Answer 40

Aspirin/ colchicine

Question 41

2-10 weeks post AMI, chest pain, fever, pleuropericarditis?

Answer 41

Dressler’s treat w/ aspirin and colchicine

Question 42

How to treat someone coming back in shock, w/ RV infarction?

Answer 42

Give 1-2 L normal saline begin inotrope support w/ dobutamine

Question 43

What is the most sensitive sign for HF?

Answer 43

Dyspnea on exertion

Question 44

What is the most specific signs of HF?

Answer 44

PND,orthopnea, edema

Question 45

What is the exam w/ highest for HF?

Answer 45

S3 A abdominojugular reflex and JVD are the other two

Question 46

Risk factors for HF?

Answer 46

1. HTN 2. Diabetes 3. Valvular heart disease 4. Old 5. Male 6. Obese

Question 47

What is abnormal BnP?

Answer 47

>500

Question 48

POC ultrasounds in HF show what?

Answer 48

B lines

Question 49

For normo-tensive HF how much diruetic how much do you give them?

Answer 49

Their daily dose, or double the daily dose

Question 50

Kid that dies while exercising?

Answer 50

HOCM

Question 51

Child w/ heart attack?

Answer 51

Sickle cell

Question 52

What causes primary cardiomyopathies?

Answer 52

Heart tissue only