ACS

Question 1

Myocardial Infarction Type 1 is defined by which of the following?

Answer 1

Related to atherosclerotic plaque rupture, ulceration, fissuring, erosion, or dissection with intraluminal thrombus in one or more of the coronary arteries, leading to decreased myocardial blood flow or distal platelet emboli and thereby resulting in myocyte necrosis.

Question 2

When the myocardium experiences a period of ischemia and then undergoes reperfusion, reperfusion injury may result in a period of depressed myocardial contractility that is termed myocardial stunning.
True or False?

Answer 2

True

Question 3

The extraction of oxygen from the coronary blood that perfuses the heart is increased when the:

Answer 3

Ratio of coronary flow to myocardial oxygen consumption is decreased

Question 4

Insufficient blood flow to the myocardium causes which of the following electrical changes?

Answer 4

Injury currents that produce ST segment changes in the electrocardiogram

Question 5

If a region of the left main coronary artery becomes stenotic such that its diameter is reduced by 50%, how will this impact blood flow to the myocardium supplied by this artery?

Answer 5

Maximal coronary blood flow capacity will be reduced in the absence of collateralization

Question 6

If a coronary vasodilator drug is administered when stenotic lesions are present in the left main coronary artery, and in the left anterior descending coronary artery just distal to the circumflex branch, which of the following may occur?

Answer 6

Decreased blood flow in the left anterior descending artery

Question 7

Which patient(s) are most at risk for developing coronary artery disease?
Select ALL that apply.

Answer 7

An overweight 32-year-old with a 2 ppd smoking history.

A late 40’s female whose father died of MI at a young age.

A 30-year-old Type 1 diabetic

Question 8

Coronary artery dissection can happen spontaneously and is more common in women than men.
True or False?

Answer 8

True

Question 9

A patient is 36 hours post myocardial infarction. The patient is starting to complain of chest pain when they lay flat or cough. You note on auscultation of the heart a grating, harsh sound. What complication is this patient mostly likely suffering from?

Answer 9

Pericarditis

Question 10

After a myocardial infraction, at what time (approximately) do the neutrophils begin to congregate at the infarction site due to inflammation?

Answer 10

24 hrs

Question 11

Your patient has been on heparin for several days while awaiting transfer for angiography. Which of the following lab results is cause for concern?

Answer 11

Platelets 125,000

Question 12

PCI has a lower bleeding risk than fibrinolytics. True or False?

Answer 12

True

Question 13

Which of the following is NOT an absolute contraindication to thrombolytics?

Answer 13

Advanced Liver Disease

Question 14

Which anti-platelet has the lowest risk of bleeding?

Answer 14

Clopidrogel

Question 15

Which of the following is NOT true of CABG?

Answer 15

Vasculature from the heart is used to bypass the atherosclerotic lesion.

Question 16

Decreased sympathetic activity, especially when coupled with increased endothelial production of the vasodilators nitric oxide and prostacyclin, can precipitate Prinzmetal’s angina. True or False?

Answer 16

False

Question 17

Multiple fixed stenotic lesions can lead to a redistribution of flow within the major supply arteries of the heart under conditions of exercise or vasodilator therapy. As blood flow increases in one region of the coronary vascular network, blood flow can reciprocally decrease in another region leading to anginal pain. This condition is referred to as:

Answer 17

Vascular Steel

Question 18

Which of the following is most accurate regarding the physical examination findings associated with MI?

Answer 18

In patients with inferior wall MI with RV involvement, JVD is an indicator of failure of the right ventricle.

Question 19

When patients come to the emergency department with atrial fibrillation, which of the following may be an indication of increased risk for MI among those who do not have a primary diagnosis of ST-segment elevation MI (STEMI) or non–ST-segment elevation MI (NSTEMI)?

Answer 19

Elevated Troponin

Question 20

Which of the following is accurate about the etiology of ACS?

Answer 20

Most cases of ACS occur from disruption of a previously non-severe lesion

Question 21

NSTEMI’s do not result in transmural infarction and are therefore not candidates for emergent PCI. True or False?

Answer 21

False