Ami 1

Question 1

How much is chest pain % in AMI?

Answer 1

10%
Equivalent pain include dyspnea, epigastric pain and pain in left arm and jaw

Question 2

Differential diagnosis of chest pain?

Answer 2

Pulmonary emoblism, aortic dissection, pneumothorax

Question 3

What are the arteries that AMI mostly occur in?

Answer 3

Right coronary a.
Left coronary a.—>circumflex a, anterior interventricular a.

Question 4

Why is Virchow’s triad associated with AMI?

Answer 4

Bcz it includes endothelial damage (caused by plaque rupture/erosion) +blood stasis and hypercoagulability

Question 5

When does troponin lvls increase?

Answer 5

In NSTEMI

Question 6

What is the difference between stable and unstable plaque?

Answer 6

Stable plaque has thicker fibrous cap, unlike unstable plaque which has thinner fibrous cap and if it ruptures it will lead to acute coronary syndrome

Question 7

What is the difference between stable and unstable angina ?

Answer 7

In stable angina , the pain is constant during exercise, pain lasts <10min, pain occurs only while exercising, ST depression, relieved with nitrates

, while in unstable angina the pain gradually increases within 2wks while exercising, pain lasts >10 min, pain occurs while at rest or minimal exertion, ST depression, NOT relieved with nitrates,

Question 8

How do you confirm the difference between NSTEMI and STEMI?

Answer 8

On several EKG, the presence of ST elevation persistently for more than >20min

Question 9

What is the difference between unstable angina and NSTEMI?

Answer 9

High troponin lvls in NSTEMI, while normal lvls in USAP

Question 10

What is the difference between MI type 1 and 2?

Answer 10

Type 1 : MI caused by atherosclerotic plaque rupture
Type 2: mismatch between oxygen supply/demand

Question 11

What are the 4 pathophysiological processes of ACS?

Answer 11

1-disruption of unstable atheromatous plaque(type1MI)
2-coronary arterial vasoconstriction
3-intraluminal narrowing caused by atherosclerosis or restenosis after stenting
4-mismatch in O2 demand/supply (type2 MI)

Question 12

Pathophysiology of stable angina and ACS are classified into 2:

Answer 12

1-Dec O2 supply: -flow limiting stenosis, anemia, plaque obstruction ,
2-Inc O2 demand

Question 13

When do we see partial vs complete arterial obstruction ?

Answer 13

Partial: NSTEMI and unstable angina
Complete: STEMI

Question 14

**what is the most common component in the thrombus of USAP/NSTEMI vs STEMI

Answer 14

USAP/NSTEMI: platelets are most common
STEMI: FIBRINS—>total occlusion

Question 15

Describe chest pain that suggest low vs high probability of ischemia?

Answer 15

High: central; crushing, pressure, squeezing, gripping, tightness, heaviness, retrosternal*
Low: peripheral; fleeting, shifting, pleuritic, positional

Question 16

Location of pain in ACS?

Answer 16

Central chest, back, neck, jaw, epigastric pain and left shoulder

Question 17

‘’ risk factors for cardiac related chest pain?

Answer 17

Diabetes Miletus
Old age
Male
Renal insufficiency
Hypertension
Hyperlipidemia
Family history
Peripheral and carotid artery disease
Known CAD

Question 18

Most imp finding in physical exam for ACS?

Answer 18

Diaphoresis

Question 19

What are the ECG findings in NSTEMI?

Answer 19

-transient ST elevation <20min
-persistent/transient ST depression
-T wave inversion/flattening
-can be normal

Question 20

‘’’ in which leads is the occlusion of left circumflex artery detected?

Answer 20

V7-V9

Question 21

‘’’ in which leads is the occlusion of right ventricular MI detected?

Answer 21

V3R and V4R

Question 22

Even if the EKG is normal in a pt with chest pain, what should be done?

Answer 22

EKG should be repeated every 20-30min

Question 23

Which layer of the heart is more prone to ischemia?

Answer 23

Subendocardial layer

Question 24

Which layer is affected in NSTEMI vs STEMI?

Answer 24

NSTEMI(ST depression+T inversion): subendocardial layer
STEMI: Transmural

Question 25

When do you see T wave inversion?

Answer 25

NSTEMI

Question 26

Identify J point on EKG

Question 27

Second main therapy for NSTEMI-ACS?

Answer 27

Angiography then revascularization

Question 28

First main therapy for NSTEMI-ACS?

Answer 28

Antiplatelet: Aspirin (TxA2 rec)+ADP inhibitors/P2Y12(Clopidogrel,Prasugrel, Ticagrelor)
+
Anticoagulant: unfractioned heparin(UFH) or Enoxaparin

Total: Enoxaparin+aspirin(300mg)+Prasugrel(60mg) “PEA”