ACS

Question 1

Unstable Angina

Answer 1

Clinical presentation
- angina lasting longer than 20 min
- new onset that markedly diminishes physical activity
- increasing angina - lasts longer, more frequent with less exertion
Normal biomarkers of myocardial injury

Question 2

NSTEMI

Answer 2

Clinical presentation

Elevated biomarkers of myocardial injury

Question 3

STEMI

Answer 3

Clinical presentation
Elevated biomarkers of myocardial injury
ECG evidence of ST-segment elevation
- > 1 mm in 2 or more contiguous leads

Question 4

ACS Protocol

Answer 4

Antiplatelet 
- theopyridines - Clopidogrel (Plavix) 
- Asprin
Beta blockers ('ol) -  Metoprolol
Nitrates - nitroglycerine
Heparin
Additionally:
- statin/anti-lipid (HMG-CoA Reductase inhibitor - Atorvastatin
- ace-inhibitor - Ramipril

Question 5

Immediate Treatment

Answer 5

Morphine
Oxygen
Nitro
Asprin

Question 6

PCI

Answer 6

Preferred reperfusion therapy in specific subsets of patients with ACS

• STEMI
• new LBBB
• true posterior infarction

Question 7

TIMI

Answer 7

Thrombolysis in Mycardial Infarction

• pts who will derive the greatest benefit from aggressive medial therapy with glycoprotein IIb/IIIa inhibitors and early PCI
  1. age > 65
  2. 3 or more CAD risk factors (dislipidemia, htn, DM, obesity, smoking, stress, lack of physical activity, poor diet)
  3. known CAD - stenosis > 50%
  4. aspirin within the last 7 days
  5. severe angina, 2 or more episodes in the last 24 hours
  6. EKG ST changes > 0.5 mm
  7. positive cardiac marker

Question 8

High risk (TIMI 5 - 7)
Intermediate risk (TIMI 3 - 4)

Answer 8

Initial therapy
- Aspirin, B-blocker, nitrates, statin, LMWH or UFH, GP IIb/IIIa inhibitor
Consider
- clopidogrel and early coronary angiography

Question 9

Low Risk (TIMI 0 - 2)

Answer 9

Initial therapy
- aspirin, B-blockers, nitrates, statin, thienopyrines
Consider:
- LMWH, UFH and predischarge stress test

Question 10

Types of MI

Answer 10

Type 1 - spontaneous ischemic event
Type 2 - supply demand mismatch
Type 3 - sudden cardiac death
Type 4a - PIC intervention
Type 4b - in-stent thrombosis
Type 5 - coronary artery by-pass surgery