IHD (UA, STEMI, NSTEMI)

Question 1

What is Acute Coronary Syndrome (ACS)?

Answer 1

A clinical spectrum of IHD ranging from UA, NSTEMI to STEMI depending upon the degree and acuteness of coronary occlusion

Question 2

What is the difference between UA and STEMI & NSTEMI?

Answer 2

UA has no myocardial injury and cardiac biomarkers are normal while STEMI & NSTEMI, the cardiac biomarkers are raised

Question 3

What is Myocardial Infarction (MI)?

Answer 3

MI is a myocardial injury or necrosis due to ischaemia indicated by a rise and fall of serum cardiac biomarkers (i.e cardiac troponin)

Question 4

How MI are diagnosed?

Answer 4

With a rise/fall of cardiac troponin and and accompanied with at least one of the following:

1. clinical history consistent with chest pain of ischaemic origin
2. ECG changes
3. Imaging evidence of new loss of viable myocardium or new regional wall motion abnormality
4. identification of and intracoronary (IC) thrombus by angiography or autopsy.

Question 5

what is reinfarction?

Answer 5

MI that occurs within 28 days of the incident event while recurrent MI occurs after 28 days

Question 6

STEMI happens

Answer 6

an injury that transects the entire thickness of the myocardial wall
results in an STEMI.

Question 7

NSTEMI happens

Answer 7

:limited to the subendocardial myocardium and is usually smaller and not as extensive as an STEMI
: NSTEMI differs from UA in that ischemia is severe enough to produce
myocardial necrosis resulting in the release of biomarkers, mainly
troponins T or I, from the necrotic myocytes into the bloodstream.

Question 8

An acute coronary syndrome with total occlusion is most consistent with..

Answer 8

ST segment elevation myocardial infarction

Question 9

What are typical clinical presentations of ACS?

Answer 9

angina, diaphoresis, SOB, nausea and vomitting

Question 10

What is not classified as an acute coronary syndrome (ACS)?

Answer 10

Atherosclerosis

Question 11

A PCI has a lower bleeding risk than a fibrinolytic?

Answer 11

True.

Question 12

What is not correct recommendation for patients prior to hospital arrival?

Answer 12

Patients should use transdermal nitroglycerin (if available), then wait to see if symptoms subside within 5 minutes.

Question 13

NOT true in regards to Coronary Artery Bypass Graft (CABG)?

Answer 13

Vasculature is normally taken from the heart to bypass the arthersclerotic lesions

Question 14

The “A” in MONA-B stands for “acute pain management”

Answer 14

This is false. The “A” in MONA-B stands for antiplatelet/anticoagulation. The “M” in MONA-B stands for morphine, which would fall under “acute pain management”.

Question 15

Which is not a goal in unstable angina?

Answer 15

Limit infarct size

Question 16

What is not an ABSOLUTE contraindication to fibrinolytic?

Answer 16

Current use of anticoagulants

Question 17

Which CYP is responsible for the interaction between PPIs (e.g. omeprazole) and clopidogrel?

Answer 17

CYP 2C19

Question 18

Which antiplatelet is indicated for PCI only?

Answer 18

Prasugrel

Question 19

Which antiplatelet has the lowest risk of bleeding?

Answer 19

Clopidogrel

Question 20

A male patient is being discharged from the hospital after having a STEMI. The patient has an LDL of 100 mg/dL and an HDL of 45 mg/dL with no contraindications to a statin but is not currently taking one. Which of the following choices BEST describes how to discharge statin therapy should be handled in this patient.

Answer 20

Since this patient has normal cholesterol lab values but recently had a STEMI, atorvastatin 80mg would be the best choice for therapy. Following a STEMI, a high intensity statin (e.g. atorvastatin 80mg) is recommended in ALL patients with no contraindications to a statin.