Nov23 M3-Acute Coronary Syndromes

Question 1

ACS includes what

Answer 1

unstable angina, NSTEMI, STEMI

Question 2

ACS pathophgy

Answer 2

rupture fibrous cap, thrombus formed, partially occluding (NSTEMI) or completely occluding (STEMI)

Question 3

acute MI clinical def

Answer 3

angina but more severe, lasts longer, stays at rest, no resp to nitrates

Question 4

2 tests for ACS

Answer 4

troponin (STEMI or NSTEMI) and ECG

Question 5

ECG in UA and NSTEMI vs STEMI

Answer 5

• St depression and T wave inversion

- St elevation

Question 6

UA and NSTEMI vs STEMI long term ECG

Answer 6

STEMI will keep Q waves. others: back to normal ECG

Question 7

biomarker of infarction

Answer 7

cardiac-specific troponins

Question 8

why called cardiac-specific troponins

Answer 8

cTnI and cTnT (c for cardiac are unique to heart muscle)

Question 9

troponins over time

Answer 9

peak between 18 and 36 hours . back to 0 at 10 days

Question 10

general measures in ACS

Answer 10

monitor ECG, bed rest, O2 supply if low sat, morphine for pain

Question 11

beta blocker importance in ACS

Answer 11

decreases mortality in MI patients

Question 12

UA treatment

Answer 12

ischemic so nitrate, beta blocker, CCB

Question 13

CCB contraindication

Answer 13

is negative inotropic so don’T give to severe LV dysfct

Question 14

important thing in ACS therapy

Answer 14

anti thrombotic therapy: antiplatelet or anticoag

Question 15

therapy strategies in UA and NSTEMI

Answer 15

conservative (medication) and early invasive (cath lab)

Question 16

TIMI score components (1 pt for each)

Answer 16

age over 65, CAD risk factors 3 or more, prior stenosis over 50%, St deviation, 2 anginal events in last 24hrs, ASA, cardiac biomarkers

Question 17

TIMI score use

Answer 17

3 or more: cath lab

Question 18

acute STEMI clot description + drug

Answer 18

red clot so need fibrinolytic (only works on red clot)

Question 19

acute STEMI treatment

Answer 19

cath lab

Question 20

acute meds in acute STEMI

Answer 20

ASA, heparin, beta blocker, nitrates

Question 21

fibrinolytics in UA and NSTEMI

Answer 21

don’t use, no benefit

Question 22

fibrinolytic therapy when

Answer 22

acute STEMI and no cath lab. restores blood flow in 70-80% of occlusions

Question 23

stents given with what

Answer 23

dual antiplatelet therapy to reduce ischemic complications and stent thrombosis

Question 24

dual antiplatelet therapy is what

Answer 24

aspirin + one of P2Y12 inhibitors

Question 25

meds given during PCI

Answer 25

glycoprot IIB-IIIA inhibitors

Question 26

medications given later in STEMI

Answer 26

ACEi, statins, warfarin if high risk of thromboembolism

Question 27

mural thrombus def and management

Answer 27

thrombus at apex after heart attack, give coumadin to avoid stroke

Question 28

MI: 7 drugs always given

Answer 28

beta blocker, nitrate, aspirin, P2Y12i, anticoag (UFH or LMWH), statin, ACEi