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Cardiology > NSTEMI > Flashcards

NSTEMI Flashcards

1
Q

NSTE or UA

Presence of myocyte necrosis

A

NSTEMI

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2
Q

NSTE or UA

Absence of myocyte necrosis

A

UA

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3
Q

NSTE-ACS is caused by an imbalance between myocardial oxygen supply and demand resulting from one or more of three processes that lead to coronary arterial thrombosis:

A

Plaque Fissure with Inflammation

Plaque Fissure without Inflammation
Plaque Erosion

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4
Q

chest discomfort is severe and has at least one of three features:
(1) occurrence at rest (or with minimal exertion), lasting ___
(2) of relatively recent onset (i.e., within the prior ___); and/or
(3) a ___ pattern, i.e., distinctly more severe, prolonged, or frequent than previous episodes.

A

> 10 min

2 weeks

crescendo

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5
Q

Anginal equivalents such as___

A

dyspnea, epigastric discomfort, nausea, or weakness may occur instead of chest discomfort.

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6
Q

ECG:

A

ST-segment depression
T wave changes,
new and deep T-wave inversions (≥0.3 mV)

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7
Q

Cardiac Biomarkers rises, peaks at ___after symptom onset, then gradually decreases

A

12–24 hours

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8
Q

defined by elevations of cTn >99th percentile of the upper reference limit in patients without a clear clinical history or electrocardiographic features of acute myocardial ischemia.

A

Myocardial Injury

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9
Q

The only absolute c traindications to the use of nitrates are hypotension or the recent use of a phosphodiesterase type 5 (PDE-5) inhibitor, ___ or ___ (within 24 h), or ____ (within 48 h).

A

sildenafil or vardenafil

tadalafil

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10
Q

Ambulation is permitted if the patient shows no recurrence of ischemia (symptoms or ECG changes) and does not develop an elevation of cTn for __h.

A

24h

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11
Q

Persistent symptoms after ___ doses (5 min apart): Switch to intravenous nitroglycerin (5–10 μg/min using nonabsorbing tubing)

A

3

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12
Q

Follow-Up Nitrate Use:
Topical or oral nitrates after pain resolution or replace intravenous nitroglycerin if symptom-free for ___

A

12–24 h

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13
Q

The other mainstay of anti-ischemic treatment because they reduce myocardial oxygen needs.

A

Beta blockers

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14
Q

Ordinarily, oral beta blockade targeted to a heart rate of ____beats/min is recommended.

A

50–60

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15
Q

They may be started by the intravenous route in patients with severe ischemia but should be avoided in the presence of _____

A

acute or severe heart failure, low cardiac output, hypotension, or contraindications (e.g., high-degree atrioventricular block, active bronchospasm)

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16
Q

are recommended for patients who have persistent symptoms or ECG signs of ischemia after treatment with full-dose nitrates and beta blockers and in patients with contraindications to either class of these agents.

A

Heart rate–slowing calcium channel blockers

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17
Q

Patients who have continuing severe chest pain despite maximal anti-ischemic therapy and are without contraindications to __ may receive this drug intravenously (1–5 mg every 5–30 min).

A

morphine

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18
Q

Early administration of intensive ____, such as ___, prior to percutaneous coronary intervention (PCI), and continued thereafter, has been suggested to reduce periprocedural MI and recurrences of ACS.

A

HMG-CoA reductase inhibitors (statins)

atorvastatin 80 mg/d or rosuvastatin 40 mg/d

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19
Q

In patients who do not have an adequate response to maximally tolerated statin (i.e., <50% decrease in low-density lipoprotein cholesterol [LDL-C]), addition of ____ 10 mg daily and/or a ____early after ACS have been shown to further reduce the LDL-C and prevent future cardiovascular events.

A

ezetimibe

PCSK9 inhibitor (alirocumab, evolocumab)

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20
Q

represents the second major cornerstone of treatment

A

Antithrombotic therapy consisting of antiplatelet and anticoagulant drugs

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21
Q

Contraindications to antiplatelet are

A

severe active bleeding and aspirin allergy.

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22
Q

The loading dose of clopidogrel is 600 mg, whereas the maintenance dose is 75 mg daily.

A

Clopidogrel

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23
Q

____, also a thienopyridine, achieves a more rapid onset and higher level of irreversible platelet inhibition than clopidogrel.

A

Prasugrel

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24
Q

Prasugrel is contraindicated in patients with ___

A

prior stroke or transient ischemic attack or at high risk for bleeding.

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25
Q

___, a potent, reversible platelet P2Y 12 inhibitor, reduces the risk of cardiovascular death, total mortality, or MI compared to clopidogrel across a broad spectrum of patients with ACS

A

Ticagrelor

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26
Q

the ___ gene that leads to reduced conversion of clopidogrel into its active metabolite.

A

2C19

27
Q

DAPT should continue for at least __ months (preferably ___months) in patients with NSTE-ACS without an indication for long-term full-dose anticoagulation; the duration of DAPT is dependent upon the risk of bleeding versus thrombosis.

A

3

12

28
Q

The addition of a ___ to aspirin and a P2Y 12 inhibitor (i.e., triple antiplatelet therapy) should be reserved for unstable patients undergoing PCI

A

glycoprotein IIb/IIIa inhibitor

29
Q

The ______, which has been shown to be superior to UFH in reducing recurrent cardiac events, especially in patients managed by a conservative strategy

A

low-molecular-weight heparin (LMWH) enoxaparin

30
Q

____, a synthetic factor Xa inhibitor that is equivalent in efficacy to enoxaparin but has a lower risk of major bleeding.

A

Fondaparinux

31
Q

In patients with atrial fibrillation (including patients with NSTE-ACS) treated with an oral anticoagulant who undergo PCI, the duration of ___ should be shortened (e.g., stop aspirin after hospital discharge or up to 4 weeks post PCI, except in patients at very high risk for ischemic events), and continue P2Y12 inhibitor plus DOAC for 1 year.

A

DAPT

32
Q

Coronary arteriography is carried out within ~___ h of presentation, followed by coronary revascularization (PCI or coronary artery bypass grafting), depending on the coronary anatomy (Fig. 274-4).

A

48

33
Q

Beta blockers, intensive lipid-lowering therapies to achieve an LDL-C <__ mg/dL, ACE inhibitors or angiotensin receptor blockers, and sodium-glucose co transport-2 or glucagon-like peptide 1 agonists in selected patients with type 2 diabetes mellitus (see Chap. 404), are recommended. T

A

55

34
Q

The recommended antiplatelet regimen consists of the combination of low-dose (75–100 mg/d) aspirin and a P2Y 12 inhibitor (clopidogrel, prasugrel, or ticagrelor) for ___months, unless there is a high risk of bleeding.

A

12

35
Q

Coronary angiography demonstrates ___ as the diagnostic hallmark of PVA.

A

transient coronary spasm

36
Q

___ and ___ are the main therapeutic agents for prinzmetal angina

A

Nitrates
Calcium channel blockers

37
Q

The most frequent cause of death and disability w wide.

A

ACS

38
Q

Which of the following beta blocker recommendations is appropriate for NSTE-ACS patients?
A. Intravenous beta blockers should always be administered to all patients.
B. Oral beta blockers should be titrated to a heart rate of 50-60 beats per minute.
C. Beta blockers should be given only if the patient has hypotension.
D. Beta blockers should be avoided in all patients with diabetes.

A

B

39
Q

What is the primary role of coronary computed tomographic angiography (CCTA) in patients with NSTE-ACS?
A. Assess left ventricular ejection fraction
B. Evaluate epicardial coronary artery disease
C. Determine the need for statin therapy
D. Monitor for arrhythmias

A

B

40
Q

Which of the following interventions is most appropriate for a patient with Prinzmetal’s variant angina who continues to experience ischemia-associated ventricular fibrillation?
A. Increased aspirin dosing
B. Implantable cardioverter-defibrillator (ICD) placement
C. Beta-blocker therapy
D. DAPT with ticagrelor and aspirin

A

B

41
Q

In the management of NSTE-ACS, which of the following parenteral anticoagulants requires supplementation with UFH during PCI due to the risk of catheter-related thrombosis?
A. Unfractionated heparin (UFH)
B. Low-molecular-weight heparin (LMWH)
C. Bivalirudin
D. Fondaparinux

A

D

42
Q

Which of the following is a contraindication for the use of nitrates in patients with NSTE-ACS?
A. History of diabetes
B. Hypotension
C. History of smoking
D. Elevated LDL-C

A

B

43
Q

What is the recommended LDL-C target for patients with NSTE-ACS during long-term management?
A. <70 mg/dL
B. <100 mg/dL
C. <130 mg/dL
D. <55 mg/dL
Answer: D. <55 mg/dL

A

D

44
Q

Which class of drugs is contraindicated in patients with Prinzmetal’s variant angina due to potential worsening of ischemic episodes?
A. Beta blockers
B. Calcium channel blockers
C. Nitrates
D. Aspirin

A

D

45
Q

Which biomarker is considered highly specific and preferred for diagnosing myocardial necrosis in NSTE-ACS?
A. CK-MB
B. Myoglobin
C. Cardiac troponin (cTn)
D. Lactate dehydrogenase (LDH)

A

D

46
Q

Which of the following clinical features is most characteristic of non-ST-segment elevation acute coronary syndrome (NSTE-ACS)?
A. Chest pain radiating to the right arm and jaw
B. ST-segment elevation on ECG
C. Chest discomfort occurring at rest and lasting >10 minutes
D. Elevated troponin levels with ST-segment elevation

A

C

47
Q

For patients with NSTE-ACS undergoing PCI, glycoprotein IIb/IIIa inhibitors should be reserved for which of the following scenarios?
A. All patients undergoing PCI
B. Patients who do not respond to aspirin and clopidogrel
C. Patients with high thrombus burden or recurrent ischemia on dual antiplatelet therapy (DAPT)
D. Patients receiving conservative management

A

C

48
Q

In patients with NSTE-ACS and atrial fibrillation who undergo PCI, which of the following antithrombotic regimens is recommended after 1 year?
A. Aspirin monotherapy
B. Dual antiplatelet therapy (DAPT) indefinitely
C. Oral anticoagulation monotherapy
D. P2Y₁₂ inhibitor plus aspirin

A

C

49
Q

Which of the following oral anticoagulants requires dosing adjustments based on the international normalized ratio (INR)?
A. Apixaban
B. Dabigatran
C. Vitamin K antagonists (VKA)
D. Rivaroxaban

A

C

50
Q

What is the recommended maintenance dose of rivaroxaban for a patient post-PCI, assuming they are not on treatment for atrial fibrillation or venous thromboembolism?
A. 2.5 mg once daily
B. 2.5 mg twice daily
C. 10 mg twice daily
D. 20 mg once daily

A

B

51
Q

Which of the following is a correct maintenance dose of apixaban for oral anticoagulation post-PCI, assuming no dose reduction criteria apply?
A. 2.5 mg twice daily
B. 5 mg once daily
C. 5 mg twice daily
D. 10 mg once daily

A

C

52
Q

For patients on bivalirudin, what is the recommended maintenance infusion rate following the initial IV bolus during PCI?
A. 0.5 mg/kg per hour
B. 1.75 mg/kg per hour
C. 2.0 mg/kg per hour
D. 1 mg/kg every 12 hours

A

B

53
Q

What is the initial IV bolus dose of unfractionated heparin (UFH) for anticoagulation during PCI?
A. 30–50 U/kg
B. 70–100 U/kg (maximum 5000 U)
C. 120–150 U/kg
D. 200 U/kg
Answer: B. 70–100 U/kg (maximum 5000 U)

A
54
Q

What is the recommended loading dose of aspirin for a patient with NSTE-ACS using a nonenteric formulation?
A. 75–100 mg
B. 162 mg
C. 300 mg
D. 150–325 mg

A

D

55
Q

Which of the following is an indication for intravenous nitrate therapy in the acute management of NSTE-ACS?
A. Controlled hypertension
B. Right ventricular infarct
C. Recurrent angina unresponsive to sublingual nitrates
D. Recent use of a phosphodiesterase type 5 (PDE-5) inhibitor

A

C

56
Q

Which condition is a contraindication to the use of nitrates in a patient with NSTE-ACS?
A. Hypertension
B. Hypotension
C. Vasospastic angina
D. Atrial fibrillation

A

B

57
Q

Which of the following is a reason to avoid beta blockers in the acute management of NSTE-ACS?
A. Sinus tachycardia
B. Heart rate >70 beats per minute
C. PR interval >0.24 seconds
D. Systolic pressure >100 mmHg

A

C

58
Q

In the acute management of NSTE-ACS, which therapy is recommended for patients with vasospastic angina?
A. Beta blockers
B. Calcium channel blockers
C. Aspirin
D. Clopidogrel

A

B

59
Q

For a patient with NSTE-ACS and a systolic blood pressure <90 mmHg, which anti-ischemic therapy should be avoided?
A. Calcium channel blockers
B. Beta blockers
C. Nitrates
D. All of the above

A

D

60
Q

Which of the following is an indication for the use of morphine in a patient with NSTE-ACS?
A. Mild angina managed effectively with sublingual nitrates
B. Severe angina unrelieved by 3 sublingual nitroglycerin tablets
C. Hypotension with persistent chest pain
D. Confusion and respiratory depression

A

B

61
Q

In a patient with NSTE-ACS, which of the following therapies should be considered for a patient with severe reactive airways disease who requires anti-ischemic treatment?
A. Beta blockers
B. Calcium channel blockers
C. Nitrates only
D. Morphine only

A

B

62
Q

Which anti-ischemic therapy should be avoided in a patient with NSTE-ACS who has recently taken sildenafil?
A. Beta blockers
B. Calcium channel blockers
C. Nitrates
D. Aspirin

A

C

63
Q

In patients with NSTE-ACS, which coronary artery disease finding on angiography is most common?
A. No apparent epicardial coronary stenosis
B. Single-vessel coronary artery disease
C. Three-vessel coronary artery disease
D. Left main coronary artery stenosis

A

C

64
Q

Which of the following is a characteristic feature of “vulnerable plaques” associated with NSTE-ACS?
A. Thick fibrous cap with a lipid-poor core
B. Concentric stenosis without overhanging edges
C. Eccentric stenosis with scalloped or overhanging edges and a narrow neck
D. Predominantly calcified plaques with no lipid core

A

C

Cardiology (12 decks)

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