ACS

Question 1

To call STEMI ST segment elevation should persist more than

Answer 1

20 mts

Question 2

The normal MI due to plaque rupture we see is Type

Answer 2

1

Question 3

In TMT ST depression in V1 indicates

Answer 3

Lcx disease-100% specific (but low sensitivity)

Question 4

CK MB assays to avoid Macrokinase

Answer 4

Mass assays avoid detection of Macrokinase . Usually used is activity assay

If CK MB is > 20% of total CPK Suspect Macrokinase

Chronic skeletal muscle disease like DERMATOMYOSITIS/POLYMYOSITIS CK MB fraction may be as high as 50%

Question 5

MC side effect of Ticagrelor

Answer 5

Dyspnea- More than 10%

Question 6

RV is supplied by a single coronary artery and flow in diastole is ____%

Answer 6

50% in Diastole

In LV 90% flow occurs in Diastole

Question 7

Stage 3 ECG change in Acute pericarditis

Answer 7

Diffuse T inversions :: usually after ST has become isoelectric

Stage 4 :is normal ECG

Question 8

Stage 2 ECG change in acute pericarditis

Answer 8

Seen in First week

Normalization of ST and PR segments

Question 9

ST elevation pattern in acute pericarditis

Answer 9

Diffuse ST elevation

ST depression in V1and aVR

PR elevation in aVR

PR depression in other limb leads and left chest leads ( esp V5& 6)

PR& ST change in opposite directions

Question 10

Treatment of peri infarct pericarditis

Answer 10

Avoid using NSAID for 7-10 days

Then Aspirin 650-1000mg TID for 1-2 weeks

Colchicine may be given..

Question 11

When to stop anticoagulation in PIP

Answer 11

If effusion more than 1 cm or if effusion increases 3 mm or more may consider stopping anticoagulation

Question 12

M guard stent is

Answer 12

Stent with a micronet to prevent distal embolisation

In thrombotic lesions

Higher restenosis rates

Question 13

Dose of tenecteplase in acute MI

Answer 13

30-50 mg over 5 sec

<60kg– 30 mg
>90 kg–50 mg

Question 14

Stent thrombosis mortality rate

Answer 14

Upto 40%

Question 15

Clinical and diagnostic picture of acute MI was first described in

Answer 15

1910

Question 16

LV function doesn’t normalize in……% of patients after coronary reperfusion

Answer 16

30%

Question 17

Re perfusion injury is responsible for ….% of infarct size

Answer 17

50%

Question 18

Microvascular obstruction occurs in …..% of patients after PAMI

Answer 18

40%

Question 19

Precordial Electrography was first described in

Answer 19

1944

Wilson and Rosenbaum

Question 20

Introduction of enzymes into clinical practice was in

Answer 20

1955

by La Due

Question 21

…..% of hospital deaths in first 72 hours is due to arrhythmias

Answer 21

70%

Question 22

Intensive monitoring for AMI was first started in …… to prevent arrhythmic deaths

Answer 22

1962

Question 23

Benefit of streptokinase in opening coronaries were first documented in

Answer 23

1976 by Chazov

Though streptokinase was used from 1950s the results were inconsistent

With intracoronary STK

Question 24

First angioplasty was done in

Answer 24

1977 by Gruntzig

Question 25

Stunned myocardium was first demonstrated in

Answer 25

1980 in dogs

Question 26

Hibernating myocardium was first described in

Answer 26

1978 due c/c ischemia In stunned myocardium blood flow is normal but in hibernating it is reduced Both are viable myocardium

Question 27

With coronary re perfusion in AMI ... of area at risk is saved

Answer 27

50% The rest will be scar But strategies to reduce reperfusion will reduce the scar to 25% from the 50%

Question 28

Factor Leiden V is

Answer 28

Type of Factor V which is inactivated less efficiently by Protein C

Question 29

Inherited thrombophilias means

Answer 29

Factor V Leiden- most common ProteinC,S,AT-III def Prothrombin gene mutation Total 5 inherited thrombophilias

Question 30

Arterial thrombosis and inherited thrombophilias relation

Answer 30

Testing is NOT justified as they principally cause only Venous thrombosis Further review there may be some association Uptodate

Question 31

MINOCA

Answer 31

MI with No Obstructive Coronary Atherosclerosis (<50% stenosis)

Question 32

The 3 main antiphospholipid antibodies are

Answer 32

1. aCL-anticardiolipin 2. LA- lupus Anticoagulant 3. Anti Beta 2 Glycoprotein antibody aCLAB GP

Question 33

The concept of microvascular obstruction was first posited in

Answer 33

1980

Question 34

Canakinumab is

Answer 34

IL 1-beta monoclonal Ab- a cytokine in inflammatory pathway Used in CANTOS study.Reduced hscrp, cardiac events and Cancer without reducing cholesterol

Question 35

COMPASS trial is

Answer 35

Rivaroxaban in Stable CAD and PAD along with Aspirin

Question 36

Studies which showed LDL reduction below 70 in STEMI is useful

Answer 36

IMPROVE-IT , FOURIER

Question 37

Study suggesting to give Cangrelor in STEMI if P2Y12 inhibitors are not given

Answer 37

CHAMPION

Question 38

Study suggesting Tica for 36 months in STEMI

Answer 38

PEGASUS-TIMI 54

Question 39

Study which showed routine use of deferred stenting not useful in STEMI

Answer 39

DANAMI -DEFER

Question 40

When to switch to potent P2Y12 inhibitors after fibrinolysis

Answer 40

After 48 hrs Expert opinion ESC 2017

Question 41

Role of routine revasc of Asymptomatic CAS 70-99% before CABG

Answer 41

Not indicated

Question 42

The clock for the 90 minute target to treat with PCI in STEMI starts at

Answer 42

The time of ECG diagnosis of STEMI

Question 43

In ESC DTB has been replaced with

Answer 43

FMC- first medical contact.—

Question 44

If fibrinolysis is planned for STEMI it should be given within

Answer 44

10 mts. ESC 2017 Before it was 30 mts in 2012

Question 45

Deferred Stenting is

Answer 45

Open the Artery and wait for 48 hours to implant stent In setting of primary PCI. ( Open the vessel with minimum manipulation and wait) Not recommended.ESC2017

Question 46

Cut off for administering Oxygen therapy in STEMI

Answer 46

<90% ESC 2017 Before it was 95%

Question 47

LBBB And RBBB is given equal consideration for URGENT CAG when Pt is having ischemic symptoms-as per

Answer 47

ESC 2017

Question 48

MINOCA forms—

Answer 48

14%

Question 49

Complete revasc recommendations in 2012 and 2017 ESC difference

Answer 49

2012-Not recommended 2017- To be considered at index procedure or before discharge But CULPRIT-PCI trial which came later in 2017 showed it is not the correct strategy 😃😃🤣🤣😂🤣🤣

Question 50

hSTroponin levels -limit of detection by Roche diagnostic

Answer 50

Below 5ng/L not detected 99th percentile is 14 ng/L ie 0.014ng/ml in routine Trop units

Question 51

Study which showed immediate multivessel PCI is not useful in shock

Answer 51

CULPRIT-SHOCK 2017 Came at a time when ESCs new recommendations where for complete revasc!!!🤣🤣

Question 52

A trial which showed DCB non inferior to DES in Stent restenosis

Answer 52

DARE 2017 Used a paclitaxel coated balloon

Question 53

Infarct related artery in IWMI with ST elevation in III>II and ST depression in I, aVL

Answer 53

Prox/Mid RCA

Question 54

Infarct related artery in IWMI with ST elevation inII>III and ST depression in V1-3 (OR )ST elevation in I And aVL

Answer 54

LCx or Distal occlusion of a dominant RCA Absence of ST depression in V1-3 has high negative predictive value for LCx

Question 55

Infarct related artery in IWMI with ST elevation in V1 and V4R

Answer 55

Prox RCA

Question 56

ECG findings in LAD occlusion proximal to first septal

Answer 56

complete RBBB, ST elevation in V1>2.5mm, ST elevation in aVR,ST depression in V5

Question 57

Infarct related artery if Q only in V4-6

Answer 57

LAD distal to S1

Question 58

IRA if Q in aVL

Answer 58

LAD prox to D1 ST depression inaVL- LAD distal to D1

Question 59

AWMI with inferior ST depression and ST elevation in aVL

Answer 59

LAD proximal to S1 and D1 If ST depression is absent lesion will be more distal

Question 60

ST elevation in aVR >or equal to V1 suggests

Answer 60

LMCA occlusion

Question 61

T wave changes in early STEMI

Answer 61

Tall and Broad based T waves

Question 62

Wellens syndrome is deeply inverted or biphasic T waves in

Answer 62

V2 /3 suggestive of critical LAD stenosis May extend from V1-6 Type A - biphasic T Type B- inverted T( first A then becomes B)

Question 63

AHA guidelines For thrombolysis in non PCI Hospital

Answer 63

Anticipated FMC to device time if > 2 hours give thrombolysis

Question 64

Tenecteplase is incompatible with

Answer 64

Dextrose solution Flush IV lines with Saline if dextrose was used before

Question 65

STEMI in Hospital mortality change from 1997 to 2016

Answer 65

9.8 to 5.5% in men and 18.3 to 6.9 in females NSTEMI corresponding rates are 7 to 2% and 11 to 4% ESC 2017

Question 66

Studies supporting complete revasc in STEMI

Answer 66

PRAMI and CvLPRIT. 2017

Question 67

Cut off for Oxygen administration in ACS

Answer 67

<90% saturation. ( it was 95% before ESC 2017)

Question 68

MINOCA forms ——% of all MI

Answer 68

14%

Question 69

First LARGE scale randomized Trial of O2 therapy in suspected MI

Answer 69

2017 DETO2X-AMI

Question 70

Pts with symptoms s/o AMI account for ———% of EMS consultations

Answer 70

10% ESC 2017

Question 71

ESC 2017 Guidelines for NSTEMI fast diagnosis

Answer 71

0/1 hour algorithm with Hs Troponin ( still u can miss 0.2-0.4%) Around 30% will be false positives Previous was 0/3 hour

Question 72

Percentage of AMI or ACS missed

Answer 72

2-10% 2005 JAMA

Question 73

The immediate life threatening causes of chest pain other than MI

Answer 73

Tension PnTx, PE, Dissection

Question 74

Sensitivity of the initial ECG in diagnosing AMI

Answer 74

20-60% 2005 JAMA

Question 75

Duration of classical angina pectoris according to classical teaching is

Answer 75

2-10 mts

Question 76

MI pain vs Aortic Dissection pain

Answer 76

MI pain- Crescendo pattern—ie maximum intensity after several minutes Dissection- Maximal intensity at onset. Worst pain in life

Question 77

Pericardial pain is reduced by

Answer 77

Leaning forward

Question 78

Classical teaching on NTG response in MI and Esophageal disease

Answer 78

CAD- pain relieved in less than 5 mts Esophageal- Takes more than 10 mts

Question 79

Likelihood ratio of Stabbing, pleuritic, positional or palpatory chest pain for ACS

Answer 79

0.2-0.3- means less likely. Radiation to shoulder or arm- Likelihood ratio is 4

Question 80

If cardiac hs-Troponin changes

Answer 80

20%. >20% is likely ACS Article from net