Acute Coronary Syndrome

Question 1

Acute coronary syndromes include

Answer 1

Unstable angina, myocardial infarction (these are forms of coronary heart disease, which is the most common cause of cardiovascular disease death

Question 2

typically results in an injury that transects the thickness of the myocardial wall. Pathologic Q-waves

Answer 2

STEMI

Question 3

typically is limited to sub-endocardial myocardium. Patients do not usually develop the pathologic Q wave

Answer 3

NSTEMI

Question 4

how is NSTEMI different from unstable angina

Answer 4

NSTEMI ischemia is severe enough to produce myocardial necrosis (need to draw blood, because they look alike on ECG)

Question 5

general measures for patients presenting with ACS

Answer 5

oxygen
stool softeners
bedrest
diet
anxiolytics

Question 6

this is generally preferred over fibrinolytic therapy for treating acute STEMI

Answer 6

primary PCI

Question 7

what is PCI

Answer 7

percutaneous coronary intervention. Involves the placement of a coronary stent and percutaneous transluminal coronary angioplasty (PTCA)

Question 8

dont give to a patient on a phosphodiesterase inhibitor

Answer 8

nitrates

Question 9

there is no data demonstrating efficacy at reducing cardiac events, and is primarily used for symptom relief

Answer 9

nitroglycerin

Question 10

this drug has sedative properties that tend to decrease anxiety and causes venodilation, decreases HR and BP

Answer 10

morphine

Question 11

this drug class is shown to decrease mortality but had NO recommendation for NSTEMI/UA

Answer 11

fibrinolytics

Question 12

therapy with this drug should be administered within 12 hours of symptom onset, should not be administered to pts whose symptoms begin more than 24 hours earlier

Answer 12

fibrinolytics

Question 13

patients should take this drug if they cant chew an aspirin

Answer 13

clopidrogel

Question 14

initial conservative therapy strategy that should be started ASAP after admission and continued for at least 1 month, ideally 1 year

Answer 14

clopidrogel plus ASA plus anticoagulant

Question 15

initial invasive therapy strategy that should be given prior to diagnostic angiography or PCI

Answer 15

ASA plus either clopidregel or an IV GP IIaIIIb inh (such as abciximab)

Question 16

for STEMIs, these drugs should not be given to patients aged over 75 years because of an increased risk of ICH

Answer 16

abciximab plus half dose reteplacse or tenecteplase

Question 17

for STEMIs, full dose fibrinolytic therapy should not be followed by what

Answer 17

PCI (may be harmful)

Question 18

NSTEMI- anticoagulant therapy should be added ASAP. For conservative therapy, which ones are best?

Answer 18

enoxaparin or UFH (followed by fondaparinux)

Question 19

NSTEMI- conservatively, this anticoagulant is preferred in patients who have an increased risk of bleeding

Answer 19

fondaparinux

Question 20

NSTEMI-invasively, these two anticoagulants have the strongest support

Answer 20

enoxaparin and UFH (followed by bivalirudin and fondaparinux)

Question 21

do not use this drug as the sole anticoagulant to support PCI

Answer 21

fondaparinux

Question 22

Usually UFH and LMWH are interchangeable UNLESS

Answer 22

over 75 receiving thrombolytic therapy or have significant renal dysfunction

Question 23

this class limits myocardial damage and mortality when used for acute STEMI and reduce reinfarction and mortality when used chronically post-STEMI

Answer 23

BB

Question 24

cautions to this class: HR<50 bpm, heart block, hypotension, moderate/severe LV dysfunction, COPD, asthma, signs of peripheral hypo perfusion

Answer 24

BB

Question 25

this class decreases progression to CHF, reinfarction, and mortality. It limits post infarction LV remodeling and preserves ventricular pump functions

Answer 25

ACEI

Question 26

T or F: an IV ACE inhibitor should be given to patients within the first 24 hours with anterior infarction, pulmonary congestion, or LVEF <40

Answer 26

FALSE. only oral

Question 27

this class has no beneficial effect on death or nonfatal MI. It may increase mortality in some patients (LV dysfunction or pulmonary edema)

Answer 27

CCB

Question 28

NSTEMI- these CCBs should be given to pts with continuing or recurring ischemia and in whom BB are contraindicated

Answer 28

non-dyhydropyridines (verapamil or diltiazem)

Question 29

NSTEMI- these CCB should not be administered to patients with NSTEMI/UA in the absence of a bb

Answer 29

dihydropyridines

Question 30

STEMI- these drugs should not be given to pts with STEMI and associated systolic LV dysfunction and CHF

Answer 30

verapamil or diltiazem (reasonable in pts who BB are ineffective in the absence of CHF, LV dysfunction, or AV block)

Question 31

Overall, EVERY PATIENT with NSTEMI/UA and STEMI should get:

Answer 31

ASA
NTG
BB
ACEI

Question 32

long term prevention of CAD: STEMI

Answer 32

ASA indefinitely plus

• 1-12 months of clopidrogel if metal or no stent
• at least 12 months of clopidrogel if drug eluding stent
• THROMBOLYTIC for at least 14 days

Question 33

long term prevention of CAD: NSTEMI/UA

Answer 33

ASA indefinitely plus

• 1-12 months of clopidrogel if metal or no stent
• at least 12 months of clopidrogel if drug eluding stent

Question 34

Long term prevention drugs for all patients

Answer 34

NTG (SL)
BB (unless contraindicated)
ACEI or ARB

Question 35

this class decreases CV mortality and all cause mortality in pts with a variety of cholesterol concentrations. They are good for primary and secondary prevention of MI- long term prevention

Answer 35

HMG-CoA reductase inhibitors (statins)

Question 36

this class can be used for long term prevention when BBs are not successful, contraindicated

Answer 36

CCB (verapamil and diltiazem- NOT dihydropyridine CCB)

Question 37

can be used in pts with paroxysmal or chronic atrial fib or flutter and in post MI patients

Answer 37

warfarin

Question 38

INR goal

Answer 38

2.0-3.0