Acute Coronary Syndromes

Question 1

Acute coronary syndromes include:

Answer 1

• Unstable angina (UA)
• non-ST-segment elevation myocardial infarction (NSTEMI)
• ST-segment elevation myocardial infarction (STEMI)

Question 2

Most ACS episodes are precipitated by what?

Answer 2

Intracoronary thrombus formation at the site of atherosclerotic plaque disruption.

Question 3

ACSs result in biomechanical and mechanical changes that:

Answer 3

• impair systolic contraction
• decrease myocardial compliance
• predispose to arrythmias

(infarction initiates an inflammatory response that clears necrotic tissue and leads to scar formation)

Question 4

How are ACSs diagnosed?

Answer 4

• patient history
• ECG abnormalities
• presence of specific biomarkers in the serum (cardiac troponin T or I)

Question 5

Acute treatment of UA and NSTEMI includes:

Answer 5

• anti-ischemic therapy
• antithrombotic therapy
• anticoagulants
• statin therapy
• early coronary angiography (for patients with high-risk features)

Question 6

Acute treatment of STEMI includes:

Answer 6

• rapid coronary reperfusion
• antiplatelet therapy
• anticoagulant
• beta-blocker
• statin
• ACE inhibitors

Question 7

Potential complications of infarction include:

Answer 7

• arrythmias (e.g. ventricular tachycardia and fibrillation, and supraventricular tachycardias)
• conduction blocks (atrioventricular blocks, and bundle branch blocks)

Question 8

Right ventricular infarction results in:

Answer 8

Signs of right heart failure out of proportion to left heart failure, often with intravascular volume sensitivity and hypotension.

Question 9

Standard pharmacologic therapy on discharge includes measures to reduce the risks of:

Answer 9

• thrombosis (aspirin and a P2Y12 receptor antagonist)
• recurrent ischemia (beta-blocker)
• progressive atherosclerosis (high-intensity statin)
• adverse ventricular remodeling (ACE inhibitor)

Question 10

What should be considered for patients with LV systolic dysfunction and heart failure?

Answer 10

An aldosterone antagonist

Question 11

What therapy is indicated if an intraventricular thrombus is present?

Answer 11

Systemic anticoagulation

Question 12

What is acute coronary syndrome (ACS)?

Answer 12

Resulting from acute myocardial
ischemia presenting typically with acute chest pain.

Results from disruption of an atherosclerotic plaque → platelet aggregation and formation of an intracoronary thrombus → thrombus
transforms plaque narrowing → severe or complete occlusion.

Question 13

What are three antithrombotic mechanisms.

Answer 13

• Inactivation of Clotting Factors
• Fibrin Clot Lysis
• Platelet Inhibition and Vasodilation