CAD/ACS

Question 1

_________ is the outward symptom of ischemia

Answer 1

angina

Question 2

What is PQRST?

Answer 2

P - precipitating factors/palliative measures
Q - quality and quantity of pain
R - region and radiation
S - severity of pain
T - timing and temporal pattern

Question 3

What does patient have to take before elective PCI procedure?

Answer 3

ASA
P2Y12 inhibitor loading dose (i.e. Plavix 300mg)

Question 4

What does patient take after elective PCI procedure and for how long? (LOW RISK OF BLEEDING)

Answer 4

DAPT: minimum 6 months
SAPT: indefinitely

Question 5

What does patient take after elective PCI procedure and for how long? (HIGH RISK OF BLEEDING)

Answer 5

DAPT: 1-3 months (ASA, Plavix)
SAPT: P2Y12i until 12 months (Plavix)
SAPT: indefinitely (ASA)

Question 6

Nitrates cause ____________ which decreases _________

Answer 6

venodilation, preload
(dilate veins (before heart) less blood flow to heart)

Question 7

Two EKG findings during NSTEMI

Answer 7

-ST depression
-T wave inversion

Question 8

Troponin is released from ________ _________

Answer 8

necrotic myocytes

Question 9

Higher sensitivity troponin > __________ is considered abnormal

Answer 9

> 14 ng/L

Question 10

Conventional troponin > __________ is considered abnormal

Answer 10

> 0.05 ng/mL

Question 11

UA and NSTEMI will often be treated the same way, although UA does not lead to detectable levels of _____________

Answer 11

troponin

Question 12

___________ remodeling may occur after an ACS

Answer 12

ventricular

Question 13

What factors are involved with ventricular remodeling? (2)

Answer 13

1. activation of RAAS
2. hemodynamic factors (increase in preload and afterload)

Question 14

Ventricular remodeling can lead to what?

Answer 14

Heart failure

Question 15

What does MACE usually include?

Answer 15

Stroke
MI
Cardiovascular death

Question 16

Precipitating factors of an ACS

Answer 16

1. Recent exercise
2. Extreme weather - hot or cold
3. Large meal
4. Fright/anger
5. Sex
6. Walking against wind
7. Smoking

Question 17

Define ACS

Answer 17

acute myocardial ischemia resulting from an imbalance between oxygen demand + supply

Question 18

Reperfusion strategies for UA/NSTEMI

Answer 18

Early invasive strategy vs ischemia-guided strategy

(no fibrinolytic)

Question 19

Reperfusion strategies for STEMI

Answer 19

PCI or fibrinolytics

Question 20

Patients must receive what four things immediately upon arrival to the hospital (for ACS)?

Answer 20

M: Morphine
O: Oxygen
N: Nitroglycerin
A: Aspirin

Question 21

What is the initial dose of morphine upon arriving to the hospital?

Answer 21

4-8mg IV, followed by 2-8mg q5-15 mins

Question 22

Maintain an O2 saturation > _______% upon arriving to the hospital

Answer 22

> 90%

Question 23

SL NTG dose upon arriving to the hospital

Answer 23

0.3-0.4mg q5min x 3

Question 24

IV NTG dose upon arriving to the hospital

Answer 24

10 mcg/min, then titrate by 5mcg/min q5min
(max: 200mcg/min)

Question 25

What formulation of NTG is not recommended for ACS due to a slower onset of action?

Answer 25

Transdermal

Question 26

Tolerance to nitrates develops after > _______ hours of continuous use

Answer 26

> 24 hours

Question 27

nitrates should not be taken within 24 hours of taking which PDE inhibitors?

Answer 27

sildenafil vardenafil

Question 28

nitrates should not be taken within 48 hours of taking which PDE inhibitor?

Answer 28

tadalafil

Question 29

aspirin dose upon arriving to the hospital

Answer 29

162-325mg chewable aspirin (1 dose) *given to all patients w/o contraindications ASAP

Question 30

What is coronary angiography?

Answer 30

A heart catheter that shows which arteries in the heart have blockages

Question 31

Fibrinolytics mechanism of action

Answer 31

Convert plasminogen to plasmin, which breaks down fibrin (fibrin holds clot together)

Question 32

Which fibrinolytic is weight-based?

Answer 32

Tenecteplase

Question 33

If fibrinolytic therapy is preferred for a STEMI patient, what is the "door-to-needle" time?

Answer 33

within 30 mins of hospital arrival

Question 34

If PCI is preferred for a STEMI patient, what is the "door-to-balloon" time?

Answer 34

within 90 mins of hospital arrival

Question 35

For NSTEMI/UA patients, what does ischemic-guided reperfusion therapy mean?

Answer 35

treatment with medications no heart-catheterization

Question 36

For NSTEMI/UA patients, what does early invasive reperfusion therapy mean?

Answer 36

coronary angiography +/- revascularization (preferred for high-risk patients)

Question 37

Metoprolol and carvedilol are __________ metabolized

Answer 37

Hepatically

Question 38

Metoprolol and atenolol are dosed _______ daily

Answer 38

once

Question 39

Antiplatelet therapy durations after CABG

Answer 39

DAPT - 12 months SAPT - indefinitely

Question 40

Antiplatelet therapy durations post-ACS

Answer 40

DAPT - 12 months SAPT - indefinitely

Question 41

prasugrel loading and maintenance dosing

Answer 41

LD: 60 mg MD: 10 mg

Question 42

ticagrelor loading and maintenance dosing

Answer 42

LD: 180 mg MD: 90 mg BID

Question 43

Prasugrel is contraindicated in patients with a previous __________

Answer 43

stroke

Question 44

Aspirin dose must be < _________ mg when taken with ticagrelor

Answer 44

< 100mg