IHD (UA, STEMI, NSTEMI) Flashcards
What is Acute Coronary Syndrome (ACS)?
A clinical spectrum of IHD ranging from UA, NSTEMI to STEMI depending upon the degree and acuteness of coronary occlusion
What is the difference between UA and STEMI & NSTEMI?
UA has no myocardial injury and cardiac biomarkers are normal while STEMI & NSTEMI, the cardiac biomarkers are raised
What is Myocardial Infarction (MI)?
MI is a myocardial injury or necrosis due to ischaemia indicated by a rise and fall of serum cardiac biomarkers (i.e cardiac troponin)
How MI are diagnosed?
With a rise/fall of cardiac troponin and and accompanied with at least one of the following:
- clinical history consistent with chest pain of ischaemic origin
- ECG changes
- Imaging evidence of new loss of viable myocardium or new regional wall motion abnormality
- identification of and intracoronary (IC) thrombus by angiography or autopsy.
what is reinfarction?
MI that occurs within 28 days of the incident event while recurrent MI occurs after 28 days
STEMI happens
an injury that transects the entire thickness of the myocardial wall
results in an STEMI.
NSTEMI happens
:limited to the subendocardial myocardium and is usually smaller and not as extensive as an STEMI
: NSTEMI differs from UA in that ischemia is severe enough to produce
myocardial necrosis resulting in the release of biomarkers, mainly
troponins T or I, from the necrotic myocytes into the bloodstream.
An acute coronary syndrome with total occlusion is most consistent with..
ST segment elevation myocardial infarction
What are typical clinical presentations of ACS?
angina, diaphoresis, SOB, nausea and vomitting
What is not classified as an acute coronary syndrome (ACS)?
Atherosclerosis
A PCI has a lower bleeding risk than a fibrinolytic?
True.
What is not correct recommendation for patients prior to hospital arrival?
Patients should use transdermal nitroglycerin (if available), then wait to see if symptoms subside within 5 minutes.
NOT true in regards to Coronary Artery Bypass Graft (CABG)?
Vasculature is normally taken from the heart to bypass the arthersclerotic lesions
The “A” in MONA-B stands for “acute pain management”
This is false. The “A” in MONA-B stands for antiplatelet/anticoagulation. The “M” in MONA-B stands for morphine, which would fall under “acute pain management”.
Which is not a goal in unstable angina?
Limit infarct size
What is not an ABSOLUTE contraindication to fibrinolytic?
Current use of anticoagulants
Which CYP is responsible for the interaction between PPIs (e.g. omeprazole) and clopidogrel?
CYP 2C19
Which antiplatelet is indicated for PCI only?
Prasugrel
Which antiplatelet has the lowest risk of bleeding?
Clopidogrel
A male patient is being discharged from the hospital after having a STEMI. The patient has an LDL of 100 mg/dL and an HDL of 45 mg/dL with no contraindications to a statin but is not currently taking one. Which of the following choices BEST describes how to discharge statin therapy should be handled in this patient.
Since this patient has normal cholesterol lab values but recently had a STEMI, atorvastatin 80mg would be the best choice for therapy. Following a STEMI, a high intensity statin (e.g. atorvastatin 80mg) is recommended in ALL patients with no contraindications to a statin.
