CAD: Acute

Question 1

Group of condition similar to symptoms of chest pain
which is not, or only partially relieved by GTN

Answer 1

Acute Coronary Syndrome

Question 2

Conditions of ACS include

Answer 2

• Acute myocardial infarction (AMI)
• UA
• NSTEMI
• STEMI

Question 3

ACS arises from rupture of an
__________

Answer 3

unstable atheromatous plaque

Question 4

determine the degree of
myocardial necrosis that occurs

Answer 4

Volume of the eventual thrombus and the time
the vessel is occluded

Question 5

Chest pain that often occurs at rest, can occur suddenly, may
worsen suddenly or may be stuttering, recurring over days to weeks

Answer 5

Unstable Angina

Question 6

Symptoms similar to unstable angina but differentiated on the basis
of markers and ECG

Answer 6

Non-ST- Elevation Myocardial Infarction

Question 7

A condition that requires immediate reperfusion therapy, through
either thrombolysis or percutaneous coronary intervention (PCI)

Answer 7

ST-Elevation Myocardial Infarction

Question 8

Acute Coronary Syndrome includes

Answer 8

Unstable Angina
Non-ST- Elevation Myocardial Infarction
ST-Elevation Myocardial Infarction

Question 9

ST-Elevation Myocardial Infarction requires immediate _______

Answer 9

reperfusion therapy

Question 10

Manifestations of Acute Coronary Syndrome:
1. __________ chest pain and discomfort
2. _____________ cellular injury
3. Release of ____________ - (Troponin I and T, CK-MB, CPK,
LDH)
4. _________________s- (ST elevation, T wave inversion,
pronounced Q waves)
5. Inflammatory response from the __________
6.___________

Answer 10

1. Severe chest pain and discomfort
2. Irreversible cellular injury
3. Release of myocardial enzymes - (Troponin I and T, CK-MB, CPK,
   LDH)
4. Electrocardiogram changes- (ST elevation, T wave inversion,
   pronounced Q waves)
5. Inflammatory response from the injured myocardium
6. Coagulative necrosis

Question 11

Release of myocardial enzymes such as ________________ manifests acute coronary syndrorme

Answer 11

Troponin I and T, CK-MB, CPK,
LDH

Question 12

Electrocardiogram changes such as ____________ manifests acute coronary syndrorme

Answer 12

ST elevation, T wave inversion,
pronounced Q wave

Question 13

• Results
  from decreased oxygen and
  nutrient delivery To
  myocardium

Answer 13

Myocardial Ischemia

Question 14

Results if
ischemia progresses unresolved
or untreated

Answer 14

Myocardial Injury

Question 15

Death
of myocardial cells

Answer 15

Myocardial Infarction

Question 16

indicates full thickness
cardiac muscle injury

Answer 16

ST-segment elevation

Question 17

indicates muscle necrosis

Answer 17

pathological Q-wave

Question 18

indicates
muscle ischemia.

Answer 18

T-wave inversion

Question 19

Cardiac Markers

Answer 19

*Troponin
*Creatinine kinase

Question 20

found in cardiac and skeletal muscle

Answer 20

Troponin T

Question 21

found only in cardiac muscle

Answer 21

Troponin I

Question 22

found in cardiac and skeletal muscles

Answer 22

Troponin C

Question 23

Found primarily in the heart muscle, skeletal muscle
and brain tissue

Answer 23

Creatinine kinase

Question 24

Aids in the diagnosis of acute myocardial or skeletal
muscle damage

Answer 24

Creatinine kinase

Question 25

CK- BB

Answer 25

Brain tissues

Question 26

CK- MM

Answer 26

– Skeletal muscles

Question 27

CK-MB

Answer 27

Heart muscle

Question 28

Overall Treatment Goals for ACS 1. __________ chest pain and anxiety 2. __________ cardiac workload and _________ cardiac rhythm 3. Prevent / reduce myocardial damage by limiting the __________ and preserving the __________ 4. Prevent or arrest complications 5. Reopen ( reperfuse ) closed coronary vessel with __________________

Answer 28

1. Reduce chest pain and anxiety 2. Reduce cardiac workload and stabilize cardiac rhythm 3. Prevent / reduce myocardial damage by limiting the area affected and preserving the pump function 4. Prevent or arrest complications 5. Reopen ( reperfuse ) closed coronary vessel with thrombolytic drug and/or PCI

Question 29

Causes venous pooling and reduces preload, cardiac workload and oxygen consumption

Answer 29

Morphine

Question 30

Morphine causes venous pooling and __________ (increases/reduces) preload, cardiac workload and oxygen consumption

Answer 30

reduces

Question 31

Morphine is used for ________

Answer 31

myocardial pain and anxiety

Question 32

May cause orthostatic hypotension and fainting and Can produce bradyarrhythmia

Answer 32

Morphine

Question 33

Morphine may cause _______ and ________. It can also produce

Answer 33

orthostatic hypotension and fainting; bradyarrhythmia

Question 34

Administered in patients with arterial saturation less than 90%, respiratory distress or high risk features of hypoxemia

Answer 34

Oxygen

Question 35

Oxygen is administered in patients with arterial saturation __________________, respiratory distress or high risk features of hypoxemia

Answer 35

less than 90%

Question 36

causes venous dilation which reduces left ventricular volume (preload) and myocardial wall tension, decreasing oxygen demand

Answer 36

Nitrates

Question 37

Nitrates causes venous dilation which ________(increases/reduces) left ventricular volume (preload) and myocardial wall tension, decreasing oxygen demand

Answer 37

reduces

Question 38

also reduce arteriolar resistance, helping reduce afterload, which decrease myocardial oxygen demand

Answer 38

Nitroglycerin

Question 39

Nitroglycerin also (increase/reduce) arteriolar resistance, helping (increase/reduce) afterload, which (increase/decrease) myocardial oxygen demand

Answer 39

reduce; reduce; decrease

Question 40

T/F: Antiplatelet therapy should be initiated promptly

Answer 40

T

Question 41

T/F: Aspirin should be administered as soon as possible after presentation and continued indefinitely

Answer 41

T

Question 42

should be administered to patients who cannot tolerate GI effect and those who are hypersensitive to ASA

Answer 42

Clopidogrel

Question 43

Management for STEMI

Answer 43

*Fibrinolytics Aspirin Thienopyridine Glycoprotein IIB/ IIIA Receptor inhibitor Anticoagulant Nitroglycerin Beta-blockers Calcium channel blocker

Question 44

causes the thrombus clot to be lysed when administered early after symptom onset (6 to 12 hrs) and to restore blood flow

Answer 44

thrombolytic agents/Fibrinolytics

Question 45

The conversion of _______ to ________ promotes fibrinolysis and breakdown of the clot.

Answer 45

Plasminogen to plasmin

Question 46

Therapy of choice when PCI is not available

Answer 46

Fibrinolytics

Question 47

Preferred antiplatelet agent in the treatment of all ACS

Answer 47

Aspirin

Question 48

Clopidogrel and ticlopidine

Answer 48

Thienopyridine

Question 49

Recommended to be administered to patients with ST elevation ACS if patient is allergic to aspirin

Answer 49

Thienopyridine

Question 50

First line GP IIB/IIIA receptor inhibitor for patients undergoing PCI who have not received fibrinolytics

Answer 50

Abciximab

Question 51

Should not be administered if patients who will not undergo PCI

Answer 51

Abciximab

Question 52

Combination of Abciximab with _____________________ has been shown to reduce risk of reinfarction and need for repeated PCI

Answer 52

Aspirin/thienopyridine and UFH

Question 53

Initiated at time of PCI and infusion is continued for 12 h

Answer 53

Abciximab

Question 54

Abciximab is initiated at time of PCI and infusion is continued for _______

Answer 54

12 hours

Question 55

Abciximab may (increase/decrease) risk of bleeding

Answer 55

increase

Question 56

UFH administered as continuous infusion

Answer 56

Anticoagulant

Question 57

First line anticoagulant for treatment of patients with ST elevation

Answer 57

Anticoagulant

Question 58

Should be initiated in the ED and continued for 24 hours or longer in patients who will bridged over to receive chronic warfarin therapy following MI

Answer 58

Anticoagulant

Question 59

Dose is frequently adjusted to a target activated partial thromboplastin time (aPTT)

Answer 59

Anticoagulant