ACS

Question 1

What does ACS stand for?

Answer 1

Acute coronary syndrome.

Question 2

What conditions are included under ACS?

Answer 2

Unstable angina, NSTEMI, and STEMI.

Question 3

What is chronic coronary disease (CCD)?

Answer 3

The stabilized presentation of CAD, including stable angina, silent ischemia, and Prinzmetal’s angina.

Question 4

What is unstable angina?

Answer 4

Transient ischemia due to blockage that occurs with or without exertion, without myonecrosis.

Question 5

What is NSTEMI?

Answer 5

Non-ST elevation myocardial infarction caused by partial occlusion of a coronary artery with myonecrosis present.

Question 6

What is STEMI?

Answer 6

ST-elevation myocardial infarction caused by complete coronary blockage with myonecrosis present.

Question 7

What 3 things are needed to define an MI?

Answer 7

Evidence of ischemia, rise and/or fall of troponin, and clinical signs of myocardial injury.

Question 8

What are examples of clinical signs of myocardial injury in MI?

Answer 8

Symptoms/signs, new ECG changes, or imaging evidence of cardiac damage or blockage.

Question 9

What is the basic pathophysiology of ACS?

Answer 9

Vulnerable plaque ruptures, causing platelet and clotting activation, leading to blockage, ischemia, and then myonecrosis.

Question 10

What are classic ACS symptoms?

Answer 10

Substernal chest pain or discomfort, pain radiating to arms/shoulders/back/abdomen/jaw, nausea, vomiting, and shortness of breath.

Question 11

In which groups can ACS present atypically?

Answer 11

Women, elderly patients, and patients with comorbidities.

Question 12

What clinical signs may be seen in ACS?

Answer 12

Hypertension or hypotension, tachycardia, bradycardia, arrhythmias, JVD, and pulmonary edema.

Question 13

What 3 major diagnostic tools are used in ACS?

Answer 13

Coronary angiography, ECG, and cardiac troponin trends.

Question 14

What does coronary angiography help determine in ACS?

Answer 14

Whether the blockage is partial or complete.

Question 15

What does the ECG help determine in ACS?

Answer 15

Whether ST elevation is present.

Question 16

When is cardiac troponin released after injury?

Answer 16

About 2–4 hours after injured cardiac cells release it.

Question 17

Why is hs-cTn preferred over regular troponin?

Answer 17

It shows faster changes, usually within 1–2 hours.

Question 18

What do dynamic troponin changes suggest?

Answer 18

An acute problem.

Question 19

What do stable troponin levels suggest?

Answer 19

No damage or chronic damage rather than an acute event.

Question 20

What does MONA stand for?

Answer 20

Morphine, Oxygen, Nitroglycerin, Aspirin.

Question 21

What does THROMBINS² stand for?

Answer 21

Thienopyridine (P2Y12 inhibitor), Heparin, RAAS system, Oxygen, Morphine, Beta-blocker, Intervention, Nitroglycerin, Salicylate (aspirin), Statin.

Question 22

When should oxygen be given in ACS?

Answer 22

If the patient is hypoxic.

Question 23

When should oxygen NOT routinely be given in ACS?

Answer 23

If the patient is not hypoxic.

Question 24

What is nitroglycerin used for in ACS?

Answer 24

Symptomatic relief; it does not improve clinical outcomes.

Question 25

When is morphine used in ACS?

Answer 25

When nitroglycerin is ineffective for analgesia.

Question 26

What is an important downside of morphine in ACS?

Answer 26

It may delay absorption of P2Y12 inhibitors.

Question 27

Is aspirin indicated for all ACS patients?

Answer 27

Yes.

Question 28

What is the aspirin loading dose in ACS?

Answer 28

325 mg.

Question 29

What aspirin formulation is preferred initially in ACS?

Answer 29

Chewable aspirin for faster onset.

Question 30

In NSTE-ACS, when is PCI generally pursued?

Answer 30

In high-risk patients.

Question 31

In lower-risk NSTE-ACS, what may be used instead of immediate PCI?

Answer 31

Medical management.

Question 32

What GRACE score suggests high risk in NSTE-ACS?

Answer 32

Greater than 140.

Question 33

What HEART score suggests high risk in NSTE-ACS?

Answer 33

7–10.

Question 34

In STEMI, what is the goal time to be in the cath lab from first medical contact?

Answer 34

Within 90 minutes of first medical contact.

Question 35

When is fibrinolysis preferred in STEMI?

Answer 35

Only if PCI is not feasible within 120 minutes from first medical contact.

Question 36

Is fibrinolysis used for NSTEMI or unstable angina?

Answer 36

No, fibrinolysis is for STEMI only.

Question 37

What are the fibrinolytics listed in the slides?

Answer 37

Tenecteplase, alteplase, and reteplase.

Question 38

What is the mechanism of fibrinolytics?

Answer 38

They bind fibrin and convert plasminogen to plasmin, which breaks down clots.

Question 39

What is a major adverse effect of fibrinolytics?

Answer 39

Intracranial hemorrhage and major bleeding.

Question 40

What is DAPT?

Answer 40

Dual antiplatelet therapy: aspirin plus a P2Y12 inhibitor.

Question 41

Is DAPT used for all ACS patients?

Answer 41

Yes, all ACS patients should get aspirin plus an oral P2Y12 inhibitor, with specifics depending on intervention and patient factors.

Question 42

Which P2Y12 inhibitor is preferred for fibrinolysis-treated ACS?

Answer 42

Clopidogrel.

Question 43

Which P2Y12 inhibitor is used only after PCI?

Answer 43

Prasugrel.

Question 44

Which P2Y12 inhibitor is contraindicated in patients with prior stroke or TIA?

Answer 44

Prasugrel.

Question 45

Which P2Y12 inhibitor is associated with dyspnea?

Answer 45

Ticagrelor.

Question 46

In patients with ACS, should prasugrel be given before coronary anatomy is known in NSTE-ACS?

Answer 46

No, the slide notes prasugrel should not be given before coronary anatomy is known in NSTE-ACS.

Question 47

What is the default DAPT duration after ACS?

Answer 47

About 12 months, though duration may change depending on bleeding risk, PCI, and need for oral anticoagulation.

Question 48

When are GP IIb/IIIa inhibitors used in ACS?

Answer 48

In patients undergoing PCI with large thrombus burden, no-reflow, or slow flow; not routinely used.

Question 49

Which GP IIb/IIIa inhibitors are listed in the slides?

Answer 49

Tirofiban, abciximab, and eptifibatide.

Question 50

Is anticoagulation indicated for all ACS patients?

Answer 50

Yes, some form of anticoagulation is indicated for all patients with ACS.

Question 51

Which anticoagulant is preferred when PCI is anticipated?

Answer 51

Heparin.

Question 52

Which anticoagulants are guideline-preferred in non-PCI intervention because they are less invasive?

Answer 52

Enoxaparin and fondaparinux.

Question 53

Are beta-blockers indicated in ACS?

Answer 53

Yes, for patients without contraindications, early oral beta-blocker therapy is recommended.

Question 54

What benefit do early beta-blockers provide in ACS?

Answer 54

They reduce reinfarction risk and ventricular arrhythmias.

Question 55

Are statins indicated for all ACS patients?

Answer 55

Yes, high-intensity statin therapy is recommended for all ACS patients.

Question 56

When should nonstatin lipid-lowering therapy be added in ACS?

Answer 56

When appropriate based on lipid guidelines, such as patients already on maximal statin therapy with LDL-C still elevated.

Question 57

Are ACE inhibitors or ARBs used in ACS?

Answer 57

Yes, ACEi or ARB therapy is recommended or reasonable depending on patient risk.

Question 58

In which ACS patients should an MRA be added?

Answer 58

In patients with HFrEF and/or diabetes.