SCA -JAMA

Question 1

When a patient 50 years or younger presents with ACS and does not have traditional risk factors…

Answer 1

A toxicology screen should be performed because
cocaine or marijuana is an instigating factor in approximately 10% of ACS among patients in this age range.

Question 2

What occurs when thrombosis completely occludes the vessel?

Answer 2

STEMI

Question 3

What happens when the thrombus is non-occlusive?

Answer 3

Non-STEMI

Question 4

What Are ACS?

Answer 4

ACS refer to a sudden reduction in blood supply to the heart muscle due to ST-segment elevationmyocardial infarction (STEMI), non-STEMI (NSTEMI), or unstable angina.

Question 5

What Causes ACS?

Answer 5

The most common cause of ACS is rupture of atherosclerotic plaque with thrombus formation.

Other less-frequent causes include plaque erosion, calcific nodules, coronary spasm, spontaneous coronary artery dissection, coronary embolism, and myocardial infarction with nonobstructive coronary arteries.

Question 6

What´s the definition of MINOCA?

Answer 6

Acute MI associated with a rise and fall of troponin on serial assessment with at least 1 value above the 99th percentile upper reference limit, combined
with clinical evidence of infarction, nonobstructive coronary arteries on angiography, and no alternative etiology to explain the diagnosis

Question 7

Older patients and patients with diabetes may be more likely to present with symptoms such as

Answer 7

Shortness of breath rather than chest pain

Question 8

Common non–chest pain symptoms in people with ACS include:

Answer 8

Pain between the shoulder blades, neck pain, palpitations, jaw pain, nausea or vomiting,
fatigue, shortness of breath, indigestion, dizziness, syncope, stomach or epigastric pain, left arm and shoulder pain, and diaphoresis

Question 9

When a patient presents with symptoms of ACS but does not have ST-segment elevation….

Answer 9

Rapid testing with high-sensitivity troponin,
such as cardiac troponin T or I, should be performed.

Question 10

What´s the utility of exercise stress testing with or without myocardial imaging, or noninvasive computed tomographic (CT) coronary angiography?

Answer 10

Can stratify risk in patients who do not have electrocardiographic abnormalities, troponin elevation, arrhythmia, hemodynamic instability, or ongoing chest pain and determine whether they have symptomatic coronary artery disease

Question 11

What´s the importance of the COMPLETE trial?

Answer 11

Patients with non-ST STEMI and muitivessel disease underwent either

• Revascularization of every significant stenosis in all major coronary arteries or
• Treatment of the culprit coronary artery without additional revascularization.

At a median follow-up of 3 years, death from cardiovascular causes or new MI occurred in 7.8% of patients in the complete revascularization group vs 10.5% of patients in the group in which only the culprit
lesion was treated

Question 12

What are the initial therapeutic options for patients with NSTE-ACS, if the first or subsequent troponin
measurements are increased above the 99th percentile upper reference limit?

Answer 12

• Conservative (medical)
• Invasive (coronary angiography followed by revascularization)

Question 13

Meta-analyses conservative vs invasive strategies

Answer 13

Most supported an early invasive approach for patients
who are at moderate to high risk, as determined by abnormal troponin levels, electrocardiographic changes, or risk scores.

Question 14

Doble antiagregación ASA + clopi por cuánto tiempo

Answer 14

1 año

Question 15

Another option for long term antithrombotic therapy is:

Answer 15

Low dose aspirin +rivaroxa 2.5mg twice daily