100114 acute coronary syndromes

Question 1

acute coronary syndrome-most important distinction to make between types?

Answer 1

one that causes ST elevation on ECK (this would be a STEMI) and those that do not (unstable angina, NSTEMI)

Question 2

clinical cardiac findings for MI

Answer 2

S4 (and S3 if systolic dynsfxn is present) gallop

dyskinetic bulge in anterior wall MI

systolic murmur (if mitral regurgitation or ventricular septal defect)

review other findings on slide

Question 3

Q waves

Answer 3

sign of transmural infarct

Question 4

ECG abnormalities for unstable angina/NSTEMI

Answer 4

ST segment depression and/or T wave inversions

may be transient and correlate with chest pain in the case of unstable angina, or persist in the case of NSTEMI

Question 5

ECG abnormalities of STEMI

Answer 5

initial ST segment elevation, followed over the course of hours by inversion of the T wave and Q wave development (if no treatment)

Q wave persists for weeks (if no treatment)

Question 6

serum markers of infarction

Answer 6

rise above a threshold level with NSTEMI and STEMI

cardiac troponins (cTnl, cTnT)
creatinine kinase

Question 7

symptoms of UA vs NSTEMI vs STEMI

Answer 7

UA: crescendo, rest, or new-onset severe angina

NSTEMI and STEMI: prolonged crushing chest pain; more severe and wider radiation than usual angina

Question 8

critical difference in appraoch to treating pts with STEMI vs UA/NSTEMI

Answer 8

pts with STEMI typically benefit from immediate reperfusion therapies whereas pts with NSTEMI do not

Question 9

most important predictor of post-MI outcome is

Answer 9

extent of left ventricle dysfxn

Question 10

standard post-discharge therapy for MI

Answer 10

aspirin
beta blocker
HMG-CoA reductase inhibitor
ACE inhibitor (if LV dysfxn)