Clinical Assessment of ACS

Question 1

Thrombolysis in myocardial infarction (TIMI) risk score

Answer 1

1 point is given for each of the following: 65 or older, three or more risk factors for CAD, prior coronary stenosis 50% or greater, ST deviation on ECG, two or more anginal events in previous 24 hours, aspirin use in previous 7 days, and elevated cardiac biomarkers

Question 2

TIMI score assessment

Answer 2

Risk of mortality, new or recurrent MI, or severe recurrent ischemia through 14 days; 0–2 is low risk, 3 is intermediate risk, and 4 or more is high risk

Question 3

NSTE-ACS UA objective findings

Answer 3

ST-segment depression, T-wave inversion, or transient or nonspecific ECG changes
No positive biomarkers for cardiac necrosis

Question 4

NSTEMI objective findings

Answer 4

ST-segment depression, T-wave inversion, or transient or nonspecific ECG changes
Positive biomarkers (troponin I or T elevation) - myocardial injury

Question 5

STEMI objective findings

Answer 5

ST-segment elevation > 1 mm above baseline on ECG in two or more contiguous leads
Positive biomarkers (troponin I or T elevation) -myocardial necrosis

Question 6

Fibrinolytic therapy indication

Answer 6

If PCI cannot be done within 120 minutes, performance measure for lytic administration includes a door-to-needle time of 30 minutes

Question 7

Early invasive strategy indication

Answer 7

NSTE-ACS who have refractory angina or hemodynamic or electrical instability or those with high risk on the basis of clinical findings

Question 8

Ischemia-guided therapy indication

Answer 8

Recommended for patients with a low risk score (TIMI 0 or 1, GRACE less than 109); acute chest pain with a low likelihood of ACS who are troponin negative (preferred for low-risk women)

Question 9

Initial Therapies for ACS

Answer 9

Morphine
Oxygen
Nitroglycerin
ASA
Beta Blocker

Question 10

Nitroglycerin contraindications

Answer 10

Sildenafil or vardenafil (use within 24 hr) or tadalafil (use within 48 hr); SBP < 90 mm Hg or ≥ 30 mm Hg below baseline, HR < 50 beats/min, HR > 100 beats/min in absence of symptomatic HF; right ventricular infarction

Question 11

Oral Beta blocker initiation

Answer 11

within 24 hr in patients who do not have signs of HF, evidence of low-output state, increased risk of cardiogenic shock, or other contraindications to β blockade (e.g., PR interval > 0.24 s, second- or third-degree heart block, active asthma, or reactive airway disease)