Acute Coronary Syndromes

Question 1

What abnormal heart sound is associated with Acute coronary syndromes?

Answer 1

S4 gallop due to ischemia leading to noncompliance of the Left Ventricle
-atrial systole as blood is ejected into the stiff ventricle

Question 2

What should be given before Angioplasty or Thrombolytics to lower mortality in ACS?

Answer 2

Aspirin

Question 3

How long does Myoglobin take to become abnormal in ACS?

Answer 3

1-4 hours

Question 4

How long does Myoglobin take to return to normal in ACS?

Answer 4

1-2 days

Question 5

How long does CK-MB take to become abnormal in ACS?

Answer 5

4-6 hours

Question 6

How long does CK-MB take to return to normal in ACS?

Answer 6

1-2 days

Question 7

How long does Troponin take to become abnormal in ACS?

Answer 7

4-6 hours

Question 8

How long does Troponin take to return to normal in ACS?

Answer 8

10-14 days

Question 9

What should all patients with ACS receive upon arrival?

Answer 9

2 antiplatelets: aspirin plus P2Y12-R blockers
-Clopidogrel, Prasugrel or Ticagrelor

Question 10

What adverse effect is associated with Prasugrel?

Answer 10

increased risk of hemorrhagic stroke in patients >75
-do not use if hx of TIA or stroke

Question 11

What adverse effect is associated with Ticagrelor?

Answer 11

Dyspnea

Question 12

What is the standard of care for performing PCI?

Answer 12

within 90 minutes of arriving at hospital

“door to balloon”

Question 13

What are potential complications of PCI?

Answer 13

Rupture
Restenosis
Hematoma
Distal Cholesterol Embolization

Question 14

What are contraindications to thombolytics?

Answer 14

Major bleeding or CNS bleed

Surgery within the last 2 weeks

Severe HTN >180/110

Nonhemorrhagic stroke in last 6 months

Question 15

What patients get the greatest effects of Aspirin in ACS?

Answer 15

Everyone: best initial therapy

Question 16

What patients get the greatest effects of P2Y12-R blockers in ACS?

Answer 16

angioplasty or stenting as a 2nd antiplatelet with aspirin

2 antiplatelets in all MI

Question 17

What patients get the greatest effects of Beta-Blockers in ACS?

Answer 17

Everyone: so long as started during admission

Question 18

What patients get the greatest effects of ACE-I/ARBs in ACS?

Answer 18

Everyone: best benefit with EF <40%

Question 19

What patients get the greatest effects of Statins in ACS?

Answer 19

Everyone; goal LDL < 70

Question 20

What patients get the greatest effects of LMWH in ACS?

Answer 20

After thrombolytics/PCI to prevent restenosis
initial therapy with UA

Question 21

What is the role of LMWH in ACS?

Answer 21

Prevent clot formation in coronary arteries: potentially stops progression to STEMI

Question 22

What is the action of GPIIb/IIIa inhibitors?

Answer 22

Inhibit the aggregation of Platelets

Question 23

What are the common GPIIb/IIIa inhibitors?

Answer 23

Abciximab
Tirofiban
Eptifibatide

Question 24

What patients are GPIIb/IIIa inhibitors used for in ACS?

Answer 24

Patients to undergo angioplasty and stenting

Question 25

How can an MI lead to Bradycardia?

Answer 25

It can produce vascular insufficiency to the SA node

Question 26

What ECG finding is characteristic of 3rd degree (complete) AV block?

Answer 26

Cannon A waves -atrial systole against a closed tricuspid valve

Question 27

How are symptomatic Bradycardias treated?

Answer 27

1st Line: Atropine 2nd line: Pacemaker placement

Question 28

What does the Right Coronary Artery Supply?

Answer 28

Right Ventricle (RV) AV node Inferior wall of the heart

Question 29

How do you treat Right Ventricle Infarctions?

Answer 29

High-volume fluid replacement

Question 30

What do you want to avoid in Right Ventricle Infarctions?

Answer 30

Nitroglycerin: it worsens cardiac filling by dilating veins

Question 31

How does Post-MI Tamponade/Free wall rupture present?

Answer 31

Sudden loss of Pulse Clear lungs Causes Pulseless Electrical Activity

Question 32

How do Post-MI Valve or septal Rupture present?

Answer 32

new onset of murmur and pulmonary congestion

Question 33

What murmur is caused by Papillary muscle rupture?

Answer 33

Mitral Regurgitation Murmur: best heard at the apex with radiation to the axilla

Question 34

What murmur is caused by Ventricular septal Rupture?

Answer 34

Best heard at the lower left sternal border

Question 35

What is the most accurate test to diagnose Valve rupture and septal rupture?

Answer 35

Echocardiogram

Question 36

What are clues to a possible Extension of the Infarct or Reinfarction?

Answer 36

recurrence of pain new rales on exam new increase in CK-MB sudden onset of pulmonary edema

Question 37

What is the most likely diagnosis when ECG shows Bradycardia with cannon a waves?

Answer 37

3rd degree AV block

Question 38

What is the most likely diagnosis when ECG shows bradycardia without cannon a waves?

Answer 38

Sinus bradycardia

Question 39

What is the most likely diagnosis with sudden loss of pulse and JVD?

Answer 39

Tamponade/Free wall rupture

Question 40

What is the most likely diagnosis with inferior wall MI in hx, clear lungs, tachcardia and hypotension with nitroglycerin administration?

Answer 40

Right Ventricle Infarction

Question 41

What is the most likely diagnosis with New murmur and rales/congestion?

Answer 41

Valve rupture

Question 42

What is the most likely diagnosis with New murmur and increase in oxygen saturation on entering the right ventricle?

Answer 42

Septal Rupture

Question 43

How long do you continue DAPT post MI?

Answer 43

Aspirin indefinitely 2nd antiplatelet for 6-24 months

Question 44

What patients get a statin post MI?

Answer 44

all patients to a goal LDL of <70

Question 45

What patients get an ACE-I/ARB post MI?

Answer 45

Anterior MI Heart failure EF<40%

Question 46

What patients get Spironolactone post-MI?

Answer 46

EF<40% post-MI