Acute Coronary Syndrome

Question 1

Right coronary artery

Answer 1

supplies R ventricle, R atrium, bottom of L ventricle, back of septum

Question 2

Left coronary artery

Answer 2

2 branches - circumflex supplies L atrium and side/back of L ventricle. LAD supplies front and bottom of L ventricle and front of septum

Question 3

stable angina

Answer 3

Chest pain with activity/stress. Ischemia due to demand, no infarct. Normal troponins, normal EKG. Usually relieved with SL nitroglycerin or rest

Question 4

unstable angina

Answer 4

Plaque in vessel ruptures and thrombus forms causing partial obstruction. Angina pain at rest. Increase in attacks. Normal troponins. May have ST changes on EKG.

Question 5

NSTEMI

Answer 5

non-ST segment elevation MI
ST depression on EKG
elevated troponin
subendocardial MI

Question 6

STEMI

Answer 6

ST-elevation MI
coronary artery is 100% blocked
ST elevation on EKG
elevated troponin

Question 7

Left heart catheterization/coronary angiography

Answer 7

catheter inserted in radial or femoral artery, advanced to aorta and coronary arteries, dye injected to visualize the arteries

Question 8

Risk of L cath/angiography

Answer 8

allergy to contrast dye, risk of bleeding

Question 9

tx for ACS

Answer 9

• quit smoking, avoid triggers (cold weather, overexertion, overeating), lipid control, BP control, diabetes control
• meds for vasodilation (NTG, calcium channel blockers)

Question 10

Prinzmental angina

Answer 10

vasospastic angina - due to spasm of coronary artery (not atherosclerosis) - restricts blood flow. ST elevation. TX: NTG, CCB

Question 11

TX for chest pain

Answer 11

gives nitrates and O2 to improve bld flow to arteries, aspirin to reduce platelet aggregation, morphine for pain
MONA

Question 12

Contraindications for nitroglycerin

Answer 12

hypotensive
R sided MI
use of PDE-5 (used for ED and pulmonary HTN)