Acute Coronary syndromes

Question 1

Main point of this whole packet?

Answer 1

Don’t treat unless you need to?

Question 2

What is angina pectoris defined as?

Answer 2

Acute ischemic chest pain with either rest pain or a crescendo pattern of pain on minimal exertion, associated with ECG changes of ischemia

Question 3

What are the ECG changes of ischemia?

Answer 3

ST elevation or Depression

T inversion

Question 4

What accompanies plaque rupture?

Answer 4

Bleeding into plaque

Question 5

On the TIMI risk score chart a score of 6 or 7 increase risk of death, MI, or recurrent severe ischemia requiring revascularization @14 days by what percent?

Answer 5

40%

Question 6

Global ST elevation is indicative of what?

Answer 6

pericarditis

Question 7

Global T wave inversion indicative of what?

Answer 7

Intercranial hemorrhage

Question 8

Initial management of acute ST segment elevation MI?

Answer 8

Thrombolytic if no cath lab

Emergency cath/PTCA/stent

Question 9

What is involved in invasive therapeutic strategies?

Answer 9

Cath
Percutaneous Coronary Intervention
Coronary artery bypass grafting
reserved for recurrent ischemia

Question 10

What is involved in conservative treatment?

Answer 10

Medical therapy

Question 11

What are nitrates used for in ACS control?

Answer 11

Angina control

Question 12

with what are Nitrates contraindicated with?

Answer 12

Phosphodiesterase inhibitors

RV infarction

Question 13

What will you see with a right ventricular infarction?

Answer 13

Hypotension
JVD
Clear lungs

Question 14

When do you not want to use beta blockers?

Answer 14

Hypotension
Severe bronchospasm
Bradycardia
Suspected coronary spasm

Question 15

What type of beta blocker do you not want to give?

Answer 15

One with intrinsic sympathomimetic actvity

Question 16

Aspirin reduces mortality by how much?

Answer 16

50% it is the most important

Question 17

what can you use in case of severe aspirin allergy?

Answer 17

Clopidogrel

Question 18

Aspirin combined with Clopidogrel will increase or reduce bleeding risk?

Answer 18

Increase

Question 19

Is Clopidogrel combined with aspirin better than aspirin alone in preventing MI/stroke?

Answer 19

Yes

Question 20

When should Clopidogrel be given?

Answer 20

Prior to identifying coronary anatomy
After coronary anatomy is identified
Continue for 1 year or longer in high risk patients

Question 21

Problem with Prasugrel?

Answer 21

Higher bleeding complications

Question 22

Which is better? LMWH or UFH?

Answer 22

LMWH

Question 23

What are the Gp2b3a inhibitors?

Answer 23

Abciximab
Integrilin
Tirofiban

Question 24

Where was the benefit most found for Gp2b3a inhibitors?

Answer 24

Stented diabetics

Question 25

Problem with Gp2b3a inhibitors?

Answer 25

Increased risk of major bleeding and need to monitor platelet count

Question 26

Should you combine Clopidogrel pre-treatment with heparin and Abciximab?

Answer 26

No

Question 27

Is invasive or conservative treatment better for patients with ACS?

Answer 27

Invasive is better

Question 28

What did Atorvastatin 80 prevent?

Answer 28

Reduced death/MI/Unstable angina requiring re-hospitalization and revascularization by 16%

Question 29

Which was better Atorvastatin or Pravastatin?

Answer 29

Atorvastatin