Angina and ACS

Question 1

Stable Angina

Answer 1

CP for >2m precipitated by exertion or emotional distress that is not getting worse

Question 2

3 types of ACS

Answer 2

1. Unstable Angina
2. NSTEMI
3. STEMI

Question 3

Difference between unstable angina and NSTEMI

Answer 3

NSTEMI= elevated cardiac enzymes

Question 4

Modifiable risk factors for development of CAD

Answer 4

HHCD

• Hyperlipidemia
• HTN
• Cigarrette smoking
• Diabetes (bedus)

Question 5

What are CKD, proteinuria, and chronic inflammatory states risk factors for?

Answer 5

CAD

Question 6

Explain the steps of plaque formation (5 steps)

Answer 6

1. Endothelial injury
2. LDL and Macrophage deposition
3. Foam cell formation
4. smooth muscle recruitment into tunica intima
5. deposition of ECM

Fibrous Cap with a Necrotic Center

Question 7

3 outcomes of atherslerotic plaque deposition

Answer 7

1. Aneurysm and Rupture
2. Occlusion via Thrombus
3. Stenosis

Question 8

Clinical presentation of ACS

Answer 8

CP that radiates to neck, jaw, arms (angina pectoris) 
Dyspnea
NV
Diaphoresis
Fatigue

Question 9

What groups of people should you suspect atypical presentations of ACS in?

Answer 9

Elderly
Women
Wilford Brimley (Diabetics)

Question 10

Diamond Forrester Criteria of CP

Answer 10

1. Substernal CP
2. Provoked by exertion/emotion
3. Relieved by Nitro

Question 11

Using the Diamond Forrester Criteria, define typical, atypical, and Non-Angina CP

Answer 11

Typical- all 3 components
Atypical- 2/3
Non-Anginal- <1

Question 12

What would you see on ECG in stable angina, unstable angina, NSTEMI, and STEMI?

Answer 12

Stable= NORMAL
Unstable/NSTEMI= ST depression/Inverted T wave
STEMI= ST elevation with hyper acute T wave

Question 13

Different stressors of a cardiac stress test

Answer 13

1. Exercise

2. Pharmacology- Vasodilators or Dobutamine

Question 14

3 testing modalities of a stress test

Answer 14

1. Stress ECG
2. ECHO
3. Myocardial Perfusion Imaging (MPI)

Question 15

If a person has abnormalities on ECG during a stress test, what is the next step of treatment?

Answer 15

Coronary Angiography

Question 16

STEMI ECG criteria

Answer 16

ST elevation >2mm in continuous leads or new LBBB

Question 17

NSTEMI ECG criteria

Answer 17

1. New ST depression >0.5mm in two contiguous leads
2. T wave inversions
3. prominent R waves (R/S ratio >1)

Question 18

What usually precipitates a STEMI vs a NSTEMI?

Answer 18

STEMI- occlusion of blood flow in a coronary vessel

NSTEMI- partial occlusion or complete occlusion with collateral flow

Question 19

When do Troponins typically peak?

Answer 19

10-24h

Question 20

Treatment of Stable Angina

Answer 20

Lifestyle mods
Aspirin
Statin
Anti-Anginal drugs: B-blockers, CCB

Question 21

Describe External Enhanced Counterpulsations (EECP) Therapy

Answer 21

Option to treat stable Angina. Compresses LE’s during diastole

Question 22

CABG Indications

Answer 22

1. 3 vessels @ >70% stenosis
2. Left main artery disease
3. LV dysfxn

Question 23

Describe MONA treatment for ACS

Answer 23

Morphine
Oxygen
Nitrates
Aspirin

Antiplatelet therapy

Question 24

Dual Antiplatelet Therapy (DAPT)

Answer 24

Aspirin and P2Y12 Inhibitor

Question 25

Drugs shown to improve mortality rates in MI patients

Answer 25

1. ASA 2. B-blockers 3. ACE Inhbitors

Question 26

Why does Aspirin help decrease platelet aggregation?

Answer 26

COX1 and COX2 Inhibition leads to decreased Thromboxane A2.

Question 27

Management of a STEMI

Answer 27

Percutaneous Coronary Intervention (PCI=Cath Lab) capable hospital: <90m Non-PCI: If PCI is <120m away, transfer or Thrombolytics <30m then transfer

Question 28

Inferior MI's are usually due to what artery occlusion?

Answer 28

LCx or RCA

Question 29

Lateral MI artery occlusion

Answer 29

LCx or branch of LAD

Question 30

Anterior MI artery occlusion

Answer 30

LAD

Question 31

Dressler Syndrome

Answer 31

Post MI autoimmune reaction that causes pericarditis

Question 32

Ddx of Acute MI should include what other 2 things?

Answer 32

1. PE | 2. Aortic Dissection

Question 33

Stanford Classification of Aortic Dissections

Answer 33

Type A: Involves the ascending aorta | Type B: No ascending Aorta

Question 34

Which stanford classification type of Aortic Dissections is the most common?

Answer 34

Type A

Question 35

What risk factors are associated with a young person having an aortic dissection?

Answer 35

CT disorders Nose candy Trauma

Question 36

3 ways an aortic dissection can occur

Answer 36

1. Tear in the intima that creates a false lumen 2. Intramural hematoma caused by rupture of vasa vasorum 3. Athersclerotic plaque ulcerating through intima and causing a hematoma

Question 37

Classic presentation of an aortic dissection

Answer 37

Tearing pain that radiates to the back Remember also on the Ddx is: MI, PE Other findings: Tamponade, Horner Syndrome, Mesenteric Ischemia, Hemothorax, MI, Aortic Regurge (diastolic murmur)

Question 38

Most commonly used imaging method to diagnosis aortic dissection

Answer 38

CT Angiography

Question 39

Anti-impulse therapy for Aortic Dissection

Answer 39

IV-Beta blockers +/- Vasodilators to get BP <120 and HR<60

Question 40

Which Stanford classification of Aortic Dissection has a higher mortality rate?

Answer 40

Type A- surgical management needed