Acute Coronary Syndrome
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Questions and Answers

What should a patient with a heart problem do in case of an emergency?

  • Consult a cardiologist immediately
  • Call the Centre 15 for hospitalization (correct)
  • Go to the hospital on their own
  • Take 150 to 325 mg of aspirin and wait

    • What is the primary indication for ambulatory troponin dosing in a patient?

  • A patient with a family history of heart disease
  • A patient with a history of myocardial infarction
  • An asymptomatic patient with chest pain over 72 hours ago (correct)
  • A patient with severe chest pain

    • What is the goal of a reperfusion strategy in patients with a heart attack?

  • To prevent further heart damage
  • To reduce the risk of stroke
  • To systematically treat patients within 12 hours of a heart attack (correct)
  • To manage symptoms of heart failure

    • What is the recommended dosage of aspirin in case of a heart emergency?

    <p>150 to 325 mg</p> Signup and view all the answers

    What should be done for a diabetic patient with an isolated Q wave?

    <p>Urgently refer the patient to a cardiologist</p> Signup and view all the answers

    What is the primary goal of ECG in a patient with chest pain?

    <p>To diagnose a heart attack</p> Signup and view all the answers

    What Electrocardiogram (ECG) sign appears after 24 hours?

    <p>Q wave</p> Signup and view all the answers

    What happens to the ST segment after 48 hours?

    <p>It returns to the isoelectric line</p> Signup and view all the answers

    What is characterized by the persistence of thoracic pain despite the cessation of the triggering factor?

    <p>Syndrome coronarien aigu</p> Signup and view all the answers

    Which of the following territories is associated with derivations V1, V2, and V3?

    <p>Anterior</p> Signup and view all the answers

    What is a sign that is strongly in favor of the diagnosis of unstable angina?

    <p>ST segment elevation during crisis only</p> Signup and view all the answers

    What is the term for anginal pain that is newly appeared, increasing in intensity or frequency, or occurring at rest?

    <p>Angor instable</p> Signup and view all the answers

    What is the characteristic of infarctus du myocarde?

    <p>Elevation of biomarkers (troponine or CK-MB) associated with a clinical picture</p> Signup and view all the answers

    What is a sign that is strongly against the diagnosis of unstable angina?

    <p>Absence of ST segment elevation</p> Signup and view all the answers

    What is the significance of T wave inversion?

    <p>It is a sign of ischemia</p> Signup and view all the answers

    Why is an ECG recommended in emergency for patients presenting with signs of SCA?

    <p>To establish a baseline for future comparisons</p> Signup and view all the answers

    What is the significance of a normal ECG in patients presenting with signs of SCA?

    <p>It does not exclude the diagnosis of SCA</p> Signup and view all the answers

    Which of the following territories is associated with derivations V7, V8, and V9?

    <p>Diaphragmatic</p> Signup and view all the answers

    What are the signs of SCA in diabetic patients?

    <p>Atypical pain or dyspnea</p> Signup and view all the answers

    What is the significance of Q wave presence?

    <p>It is a sign of necrosis</p> Signup and view all the answers

    What is the characteristic of the ECG in the early stages of ischemia?

    <p>Normal ECG or positive asymmetric T waves in the ischemic territory</p> Signup and view all the answers

    What is the significance of ST segment elevation?

    <p>It is a sign of unstable angina</p> Signup and view all the answers

    Can a normal ECG rule out unstable angina or infarction?

    <p>No, it cannot rule out either</p> Signup and view all the answers

    What is the term for the stage of ischemia where the sus-décalage of the ST appears?

    <p>Syndrome of menace</p> Signup and view all the answers

    Study Notes

    Acute Coronary Syndrome (SCA)

    • The syndrome coronarienne aigu (SCA) is characterized by persistent thoracic pain despite the cessation of the triggering factor (e.g., sports, cold, stress) and the administration of nitrate derivatives.

    Classification of Coronary Disease

    • The disease encompasses three entities:
      • Stable angina
      • Acute coronary syndrome without ST-segment elevation (unstable angina and non-ST-elevation myocardial infarction)
      • Acute coronary syndrome with ST-segment elevation (ST-elevation myocardial infarction)

    Unstable Angina

    • Angina is considered unstable if it is new (less than 8 weeks), increasing in frequency and severity with exercise, or occurs at rest.
    • There is no elevation of biomarkers (troponin or CK-MB).

    Myocardial Infarction

    • Myocardial infarction is characterized by elevated biomarkers (troponin or CK-MB) associated with a suggestive clinical picture and/or ECG signs (ST-segment modification, new BBB, or Q wave).

    ECG Diagnosis

    • An ECG is recommended as an emergency procedure for patients presenting with clinical signs of SCA.
    • An ECG normal does not exclude SCA.

    Clinical Signs

    • Typical symptoms of SCA include:
      • Retrosternal thoracic pain, often radiating to the neck, jaw, and/or arms
      • Non-resolutive after ceasing effort/stress and taking nitrate derivatives
      • Sweating and pallor, and possibly agitation
    • Note: Clinical manifestations can be absent, especially in diabetic patients, where atypical pain or dyspnea may suggest the diagnosis.

    ECG Signs

    • The ECG signs follow the chronology of ischemia:
      • Initially, the ECG is normal or presents broad, positive, asymmetrical T-waves in the ischemic territory.
      • After 2 hours, the ST-segment elevation appears, which translates to the syndrome of threat.
      • After 24 hours, the Q wave appears, indicating necrosis.
      • After 48 hours, the ST segment returns to the isoelectric line.
      • After 72 hours, the T waves invert, which can persist for months or even a lifetime.

    Territories of Infarction

    • Infarction can occur in various territories, including:
      • Anterior
      • Inferior
      • Right
      • Posterior (basal)
      • Diaphragmatic (inferoposterior)
      • Septal
      • Lateral
      • Apical

    ECG Patterns

    • ECG patterns can be characteristic of ischemia, including:
      • ST-segment elevation
      • Broad, positive, asymmetrical T-waves
      • Q waves
      • Negative T waves

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    Description

    This quiz covers the concept of acute coronary syndrome, its characteristics, and types. Learn about the differences between stable angina, acute coronary syndrome with and without ST segment elevation.

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