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Invasive Cardiology Board Review > ST-Elevation Myocardial Infarction > Flashcards

ST-Elevation Myocardial Infarction Flashcards

1
Q

What is the recommended ‘door-to-needle’ time for thrombolysis in STEMI management?

A

<30 minutes

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2
Q

What is the goal for total ischemic time in STEMI management?

A

<2 hours, ideally <1 hour

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3
Q

What does the Sgarbossa criteria help diagnose in patients with old LBBB?

A

STEMI

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4
Q

What score on the Sgarbossa criteria indicates a specificity of 90% for diagnosing MI?

A

≥3

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5
Q

What defines STEMI according to the 2013 ACC/AHA guidelines?

A

New ST elevation at the J point in at least two contiguous leads

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6
Q

What are the ST elevation thresholds for STEMI diagnosis in men and women?

A
  • ≥2 mm in V2 to V3 for men
  • ≥1.5 mm in V2 to V3 for women
  • ≥1 mm in other contiguous leads
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7
Q

What should be started as soon as possible in comatose patients with STEMI and out-of-hospital cardiac arrest?

A

Therapeutic hypothermia

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8
Q

What is the recommended clopidogrel loading dose for STEMI patients aged 75 years or less?

A

300 mg

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9
Q

What is the role of CABG in STEMI treatment?

A

Indicated in failed PCI or high-risk patients

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10
Q

What does the TIMI myocardial perfusion grading (TMPG) system assess?

A

Myocardial perfusion

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11
Q

What does TMPG grade 0 indicate?

A

No apparent tissue-level perfusion

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12
Q

What are the relative contraindications to β-blocker therapy in STEMI patients?

A
  • HR < 60 bpm
  • Systolic BP < 100 mm Hg
  • Moderate or severe LV failure
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13
Q

What should be done for STEMI patients with persistent ST elevations after thrombolysis?

A

Transfer directly to catheterization laboratory for PCI

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14
Q

What are the contraindications to nitrates in STEMI patients?

A
  • Hypotension
  • Marked bradycardia or tachycardia
  • Recent phosphodiesterase 5 inhibitor use
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15
Q

What is the ACC/AHA recommendation for routine use of aspiration thrombectomy?

A

Class III

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16
Q

What does the term ‘facilitated PCI’ refer to?

A

Full- or half-dose fibrinolysis with immediate transfer for planned PCI

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17
Q

What were the findings regarding bivalirudin vs. heparin plus a IIb/IIIa inhibitor in STEMI patients?

A

No significant difference for MACE or stroke

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18
Q

What is the risk associated with delayed β-blocker therapy in high-risk STEMI patients?

A

Cardiogenic shock

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19
Q

What complication is associated with holosystolic murmur in late presenters of STEMI?

A

Ventricular septal rupture or acute mitral regurgitation

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20
Q

What is the ACC/AHA Class I recommendation regarding the use of parin at the time of PCI?

A

Parin with or without a IIb/IIIa inhibitor or bivalirudin is recommended.

21
Q

What indicates a high risk for mechanical complications in a patient presenting with anterior Q wave and shortness of breath?

A

Late presentation, evidenced by 3-day symptoms.

22
Q

What is a common sign of ventricular septal rupture (VSR)?

A

Holosystolic murmur.

23
Q

What should be confirmed immediately in a patient suspected of having VSR?

A

Echocardiogram.

24
Q

What are the indications for emergent CABG?

A

Ventricular septal rupture (VSR).

25
Q

What can be used as a bridge to surgery in cases of VSR?

A

IABP, inotropes, and vasodilators.

26
Q

In the TRANSFER AMI trial, what were the three strategies for transferring high-risk STEMI patients?

A
  1. Immediate transfer for PCI within 6 hours of thrombolysis, 2. Delayed transfer for persistent ST elevations or instability, 3. Delayed transfer for angiography >24 hours after thrombolysis.
27
Q

What was the conclusion regarding immediate transfer to a PCI-capable hospital for STEMI patients?

A

Recommended for suitable patients who develop cardiogenic shock or acute severe heart failure.

28
Q

What is the Class I indication for patients who receive fibrinolytics?

A

Immediate transfer to a PCI-capable hospital for coronary angiography.

29
Q

Which contrast agents have a Class I recommendation for angiography in patients with chronic kidney disease?

A

Isosmolar and lower molecular weight contrast agents.

30
Q

What is the effect of drug-eluting stents (DES) compared to bare-metal stents (BMS)?

A

DES decreases restenosis rates without affecting mortality.

31
Q

What is the recommendation for using DES in patients who cannot comply with dual antiplatelet therapy?

A

Should be avoided.

32
Q

What were the key findings of the HORIZONS-AMI trial comparing bivalirudin and heparin?

A

Bivalirudin and heparin showed comparable outcomes in STEMI.

33
Q

What is the significance of symptom-to-balloon time in STEMI patients?

A

For every 30-minute delay from symptom onset to balloon inflation, the risk of 1-year mortality increases by 7.5%.

34
Q

What is ischemic preconditioning?

A

Brief nonlethal episodes of ischemia protect the myocardium before a prolonged ischemic event.

35
Q

What are the most frequent presenting symptoms of acute MI in women according to McSweeney et al.?

A

Shortness of breath, weakness, and fatigue.

36
Q

What is the recommendation for administering β-blockers in the acute phase of STEMI?

A

Part of the standard of care to reduce myocardial oxygen demand and improve perfusion.

37
Q

What did the Preventive Angioplasty in Acute Myocardial Infarction (PRAMI) trial find regarding multivessel PCI?

A

Associated with a reduction in composite outcomes compared to infarct-only PCI.

38
Q

What is the ‘no-reflow’ phenomenon?

A

Suboptimal myocardial perfusion despite restoration of epicardial flow.

39
Q

What is the indication to stop fibrinolysis during thrombolysis?

A

An abrupt decline in consciousness or new central nervous system deficit.

40
Q

What are some vasodilators used for treatment of no-reflow?

A

Nitroprusside, adenosine, verapamil

These medications have variable success in treating no-reflow (Rezkalla SH, et al. JACC Cardiovasc Interv 2017;10(3):215–223).

41
Q

What should be done if there is an abrupt decline in consciousness during thrombolysis?

A

Stop fibrinolysis, anticoagulation, antiplatelet agents; draw PT, aPTT, platelets, fibrinogen; obtain STAT brain imaging and neurology consultation

This is based on the algorithm for evaluation of intracranial hemorrhage complicating fibrinolytic therapy for STEMI (ACC/AHA, 2004).

42
Q

What do the ACC/AHA 2013 guidelines recommend regarding noninvasive testing for ischemia before discharge?

A

Should be performed to assess inducible ischemia in patients with STEMI without coronary angiography and without high-risk features

Exercise stress testing is preferred over pharmacologic testing unless the patient cannot exercise.

43
Q

What is the U-shaped relationship observed in critically ill patients related to glucose levels?

A

Mortality and glucose level

Tight glucose control (81 to 108 mg/dL) was associated with increased mortality compared to modest control (180 mg/dL) in the NICE-SUGAR trial (N Engl J Med 2009;360(13):1283–1297).

44
Q

What did the EPHESUS trial demonstrate regarding heart failure and MI treatment?

A

Reduced mortality with aldosterone antagonist added to beta-blocker and angiotensin inhibitor

An aldosterone antagonist is recommended for STEMI patients with no contraindications who are on an ACE inhibitor and beta-blocker with ejection fraction ≤ 0.40.

45
Q

What is indicated for a patient requiring triple therapy?

A

Warfarin, aspirin, P2Y12 inhibitor

Clopidogrel is recommended in triple therapy as per ACC/AHA 2016 guidelines on duration of DAPT (Levine GN, et al. Circulation 2016;134(10):e123–e155).

46
Q

What is the recommended duration for DAPT in patients with STEMI?

A

1 year regardless of reperfusion strategy

Clopidogrel is the only P2Y12 inhibitor studied with fibrinolytics.

47
Q

Fill in the blank: An IV form of P2Y12 inhibitor that is used if oral agents are contraindicated is _______.

A

Cangrelor

Cangrelor has not been studied with triple therapy and is not available in oral form for long-term use.

48
Q

True or False: Ticagrelor and prasugrel are associated with a lower risk of bleeding compared to clopidogrel.

A

False

Ticagrelor and prasugrel are more potent but associated with a higher risk of bleeding.

49
Q

What should be given if indicated during thrombolysis complications?

A

Protamine, cryoprecipitate, fresh frozen plasma, platelets

These should be given where clinically indicated.

Invasive Cardiology Board Review (42 decks)

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