Tintin Manual
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Questions and Answers

Which symptom is most common for patients with Acute Coronary Syndromes (ACS)?

  • Shortness of breath
  • Chest pain (correct)
  • Nausea
  • Back pain

    • What are important elements to consider in the history of patients with ACS?

  • Recent diet, exercise, and sleep patterns
  • Previous medical history of the patient's family
  • Blood pressure, heart rate, and respiratory rate
  • Timing of symptom onset, location, quality, severity, and duration (correct)

    • Which risk factor is associated with accelerated coronary artery disease (CAD) development?

  • Family history of CAD
  • High cholesterol levels
  • Long history of cocaine use (correct)
  • Older age

    • What percentage of patients diagnosed with ACS report atypical symptoms?

    <p>20% to 30%</p> Signup and view all the answers

    Which of the following is not a typical atypical symptom of ACS?

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

    What is a clinical feature associated with chest pain diagnosed as ACS?

    <p>Radiation of pain to one or both arms</p> Signup and view all the answers

    What should be discussed with patients to stratify the risk of ACS?

    <p>Risk factors for coronary artery disease (CAD)</p> Signup and view all the answers

    What is a risk factor for coronary artery disease (CAD) that can lead to ACS?

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

    What type of chest pain is associated with ACS?

    <p>Substernal or left-sided chest pain</p> Signup and view all the answers

    What can recent cocaine use cause in relation to ACS?

    <p>Acute ischemia from coronary vasospasm</p> Signup and view all the answers

    Which anticoagulant is preferred for patients in whom CABG is planned?

    <p>Unfractionated heparin</p> Signup and view all the answers

    Which antithrombin is considered an option for patients with unstable angina or NSTEMI?

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

    Which anticoagulant may be considered for STEMI patients lacking renal impairment and treated with non-fibrin specific thrombolytics?

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

    Which direct thrombin inhibitor is resistant to agents that degrade heparin?

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

    Which antiplatelet agent is not listed in the given text?

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

    Which fibrinolytic agent is not listed in the given text?

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

    What is the loading dose of aspirin for emergency treatment of STEMI?

    <p>600 mg</p> Signup and view all the answers

    What is the loading dose of clopidogrel for emergency treatment of STEMI?

    <p>600 mg</p> Signup and view all the answers

    What is the loading dose of prasugrel for emergency treatment of STEMI?

    <p>162 mg</p> Signup and view all the answers

    What is the loading dose of ticagrelor for emergency treatment of STEMI?

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

    What is the essential initial step for assessing signs of cardiac ischemia in patients with acute symptoms?

    <p>Promptly obtaining an ECG</p> Signup and view all the answers

    Which finding is diagnostic for ST-segment elevation myocardial infarction (STEMI)?

    <p>Specific criteria for ST-segment elevations in different locations</p> Signup and view all the answers

    How is non-ST-segment elevation myocardial infarction (NSTEMI) diagnosed?

    <p>By identifying elevated serum troponin in a patient with symptoms consistent with myocardial ischemia</p> Signup and view all the answers

    What is the characteristic presentation of unstable angina?

    <p>Chest pain associated with evidence of obstructive coronary artery disease</p> Signup and view all the answers

    What is the recommended initial treatment for patients with suspected Acute Coronary Syndrome (ACS)?

    <p>Administer aspirin, consider nitroglycerin and morphine sulfate</p> Signup and view all the answers

    What is the primary goal of STEMI treatment?

    <p>Reducing thrombus, limiting thrombus extension, and relieving obstructive CAD</p> Signup and view all the answers

    When is clopidogrel recommended for use in patients with ACS?

    <p>For patients with moderate to high-risk NSTEMI and STEMI</p> Signup and view all the answers

    What adjunct therapy may be considered for ongoing angina in ACS patients?

    <p>Nitroglycerin and morphine sulfate</p> Signup and view all the answers

    What can physical examination help identify in patients with acute symptoms?

    <p>Signs of hemodynamic dysfunction from cardiac strain or acute heart failure</p> Signup and view all the answers

    What is the role of risk factors in predicting myocardial infarction in patients with acute symptoms?

    <p>Not highly predictive of myocardial infarction</p> Signup and view all the answers

    What percentage of patients diagnosed with ACS report atypical symptoms?

    <p>20% to 30%</p> Signup and view all the answers

    Which of the following is a risk factor for accelerated coronary artery disease (CAD) development?

    <p>Long history of cocaine use</p> Signup and view all the answers

    What is a key clinical feature associated with chest pain diagnosed as ACS?

    <p>Radiation of pain to one or both arms</p> Signup and view all the answers

    Which risk factor should be discussed with patients to stratify the risk of ACS?

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

    What is a symptom commonly reported by patients with ACS?

    <p>Shortness of breath</p> Signup and view all the answers

    What is a characteristic presentation of unstable angina?

    <p>Chest pain at rest</p> Signup and view all the answers

    Which of the following is a risk factor for coronary artery disease (CAD) that can lead to ACS?

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

    What are important elements to consider in the history of patients with ACS?

    <p>Timing of symptom onset, location, quality, severity, and duration</p> Signup and view all the answers

    What adjunct therapy may be considered for ongoing angina in ACS patients?

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

    What is the primary goal of STEMI treatment?

    <p>Restoration of blood flow to the heart muscle</p> Signup and view all the answers

    Which anticoagulant is preferred for patients in whom CABG is planned?

    <p>Unfractionated heparin</p> Signup and view all the answers

    Which antithrombin is considered an option for patients with unstable angina or NSTEMI?

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

    Which direct thrombin inhibitor is resistant to agents that degrade heparin?

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

    What is the loading dose of Ticagrelor for emergency treatment of STEMI?

    <p>180 mg</p> Signup and view all the answers

    What is the loading dose of ticagrelor for emergency treatment of STEMI?

    <p>60 mg</p> Signup and view all the answers

    What adjunct therapy may be considered for ongoing angina in ACS patients?

    <p>Glycoprotein IIb/IIIa Inhibitors</p> Signup and view all the answers

    What percentage of patients diagnosed with ACS report atypical symptoms?

    <p>50%</p> Signup and view all the answers

    What is the role of risk factors in predicting myocardial infarction in patients with acute symptoms?

    <p>They help to stratify the risk of myocardial infarction</p> Signup and view all the answers

    What can recent cocaine use cause in relation to ACS?

    <p>Increased risk of ACS</p> Signup and view all the answers

    What is the diagnostic criteria for NSTEMI?

    <p>Elevated serum troponin and symptoms consistent with myocardial ischemia</p> Signup and view all the answers

    What is the characteristic presentation of unstable angina?

    <p>Chest pain associated with evidence of obstructive coronary artery disease</p> Signup and view all the answers

    What is the primary goal of STEMI treatment?

    <p>Reperfusion by reducing thrombus, limiting thrombus extension, and relieving obstructive CAD</p> Signup and view all the answers

    What is the initial step for assessing signs of cardiac ischemia in patients with acute symptoms?

    <p>Promptly obtaining an ECG</p> Signup and view all the answers

    Which adjunct therapy may be considered for ongoing angina in ACS patients?

    <p>Nitroglycerin and morphine sulfate</p> Signup and view all the answers

    When is clopidogrel recommended for use in patients with moderate to high-risk NSTEMI and STEMI?

    <p>Along with aspirin</p> Signup and view all the answers

    What is the role of risk factors in predicting myocardial infarction in patients with acute symptoms?

    <p>Risk factors alone are not highly predictive of myocardial infarction</p> Signup and view all the answers

    What is the recommended initial treatment for patients with suspected Acute Coronary Syndrome (ACS)?

    <p>Begin cardiac monitoring, place an intravenous line, and provide supplemental oxygen if necessary</p> Signup and view all the answers

    Which anticoagulant may be considered for STEMI patients lacking renal impairment and treated with non-fibrin specific thrombolytics?

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

    What adjunct therapy is recommended for ongoing angina in ACS patients?

    <p>Nitroglycerin and morphine sulfate</p> Signup and view all the answers

    Which anticoagulant is preferred for patients in whom CABG is planned?

    <p>Unfractionated heparin</p> Signup and view all the answers

    What is the loading dose of ticagrelor for emergency treatment of STEMI?

    <p>180 mg</p> Signup and view all the answers

    Which direct thrombin inhibitor is resistant to agents that degrade heparin?

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

    What is the role of risk factors in predicting myocardial infarction in patients with acute symptoms?

    <p>They assist in stratifying the risk of ACS</p> Signup and view all the answers

    When is clopidogrel recommended for use in patients with moderate to high-risk NSTEMI and STEMI?

    <p>As an adjunct therapy to aspirin</p> Signup and view all the answers

    What is the loading dose of prasugrel for emergency treatment of STEMI?

    <p>60 mg</p> Signup and view all the answers

    Which antiplatelet agent is not listed in the given text?

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

    What adjunct therapy may be considered for ongoing angina in ACS patients?

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

    Which antiplatelet agent has a loading dose of 600 mg PO followed by 75 mg/d?

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

    What is the loading dose of clopidogrel for emergency treatment of STEMI?

    <p>75 mg</p> Signup and view all the answers

    What is the percentage of patients diagnosed with ACS that report atypical symptoms?

    <p>20%-30%</p> Signup and view all the answers

    What is the recommended initial treatment for patients with suspected Acute Coronary Syndrome (ACS)?

    <p>Aspirin and oxygen therapy</p> Signup and view all the answers

    Which risk factor is associated with accelerated coronary artery disease (CAD) development?

    <p>Cocaine use</p> Signup and view all the answers

    What is the role of risk factors in predicting myocardial infarction in patients with acute symptoms?

    <p>Major role</p> Signup and view all the answers

    Which of the following is a diagnostic criterion for ST-segment elevation myocardial infarction (STEMI)?

    <p>Presence of Q waves on ECG</p> Signup and view all the answers

    What adjunct therapy may be considered for ongoing angina in ACS patients?

    <p>Beta-blockers</p> Signup and view all the answers

    What is the recommended initial treatment for patients with suspected Acute Coronary Syndrome (ACS)?

    <p>Cardiac monitoring and supplemental oxygen if necessary</p> Signup and view all the answers

    Which anticoagulant is preferred for patients in whom CABG is planned?

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

    Which adjunct therapy may be considered for ongoing angina in ACS patients?

    <p>Intravenous nitroglycerin</p> Signup and view all the answers

    What can recent cocaine use cause in relation to ACS?

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

    What is the characteristic presentation of unstable angina?

    <p>Chest pain with evidence of obstructive coronary artery disease</p> Signup and view all the answers

    What is the characteristic presentation of unstable angina?

    <p>Chest pain relieved by rest or nitroglycerin</p> Signup and view all the answers

    When is clopidogrel recommended for use in patients with moderate to high-risk NSTEMI and STEMI?

    <p>As an adjunct to aspirin therapy</p> Signup and view all the answers

    What adjunct therapy is recommended for ongoing angina in ACS patients?

    <p>Platelet glycoprotein IIb/IIIa inhibitors</p> Signup and view all the answers

    What is the primary goal of STEMI treatment?

    <p>Reperfusion and relieving obstructive CAD</p> Signup and view all the answers

    What should be discussed with patients to stratify the risk of ACS?

    <p>Risk factors for coronary artery disease (CAD)</p> Signup and view all the answers

    How is non-ST-segment elevation myocardial infarction (NSTEMI) diagnosed?

    <p>Elevated serum troponin with symptoms consistent with myocardial ischemia</p> Signup and view all the answers

    Which anticoagulant is considered an option for patients with unstable angina or NSTEMI?

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

    What can recent cocaine use cause in relation to ACS?

    <p>Increased risk of vasospasm-induced angina</p> Signup and view all the answers

    Which antithrombin is considered an option for patients with unstable angina or NSTEMI?

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

    Match the following clinical features with their association with chest pain in ACS:

    <p>Substernal or left-sided chest pain = Associated with chest pain diagnosed as ACS Radiation of pain to one or both arms = Associated with chest pain diagnosed as ACS Shortness of breath = Atypical symptom for patients with ACS Nausea, vomiting, or diaphoresis = Associated with chest pain diagnosed as ACS</p> Signup and view all the answers

    Match the following risk factors for coronary artery disease (CAD) with their association with ACS:

    <p>Older age = Risk factor for ACS Smoking = Risk factor for ACS Hypercholesterolemia = Risk factor for ACS Cocaine use = Atypical risk factor for accelerated CAD development</p> Signup and view all the answers

    Match the following atypical symptoms with their association in ACS diagnosis:

    <p>Back pain = Atypical symptom for patients with ACS Abdominal pain = Atypical symptom for patients with ACS Dizziness = Atypical symptom for patients with ACS Palpitations = Atypical symptom for patients with ACS</p> Signup and view all the answers

    Match the following risk factors for coronary artery disease (CAD) with their association with ACS:

    <p>Male gender = Risk factor for ACS Family history = Risk factor for ACS Hypertension = Risk factor for ACS Diabetes = Risk factor for ACS</p> Signup and view all the answers

    Match the following risk factors for coronary artery disease (CAD) with their association with ACS:

    <p>Family history = Risk factor for ACS Hypertension = Risk factor for ACS Diabetes = Risk factor for ACS NSTEMI = Atypical risk factor for ACS</p> Signup and view all the answers

    Match the following diagnostic tool with its essential role in ACS diagnosis:

    <p>Risk factors = Not highly predictive of myocardial infarction in patients with acute symptoms Physical examination = Identify signs of hemodynamic dysfunction from cardiac strain or acute heart failure ECG = Essential to assess for signs of cardiac ischemia Troponin test = Identified in a patient with symptoms consistent with myocardial ischemia</p> Signup and view all the answers

    Match the following diagnoses with the alternative conditions for patient symptoms:

    <p>Pulmonary embolism = May include alternative diagnoses for patient symptoms Congestive heart failure = May include alternative diagnoses for patient symptoms STEMI = Alternative diagnoses for patient symptoms NSTEMI = Alternative diagnoses for patient symptoms</p> Signup and view all the answers

    Match the following ACS types with their diagnostic criteria:

    <p>STEMI = Findings diagnostic for include specific criteria for ST-segment elevations in different locations NSTEMI = Diagnosed when an elevated serum troponin is identified in a patient with symptoms consistent with myocardial ischemia Unstable angina = Clinical diagnosis based on history, physical examination findings, and diagnostic testing Obstructive CAD = Associated with chest pain and evidence of obstructive coronary artery disease</p> Signup and view all the answers

    Match the following treatment options with their respective use in ACS management:

    <p>Reperfusion therapy = Includes reducing thrombus, limiting thrombus extension, and relieving obstructive CAD Aspirin = Administered for patients with suspected ACS Nitroglycerin and morphine sulfate = Considered as adjuncts for ongoing angina Clopidogrel = Recommended for use along with aspirin for patients with moderate to high-risk NSTEMI and STEMI</p> Signup and view all the answers

    Match the following initial management steps with their recommended actions for patients with suspected ACS:

    <p>Cardiac monitoring = Begin for patients with a suspected ACS Intravenous line placement = Begin for patients with a suspected ACS Supplemental oxygen = Provide if necessary for patients with a suspected ACS Aspirin administration = Administer for patients with a suspected ACS</p> Signup and view all the answers

    Match the following anticoagulants with their recommended use in patients with unstable angina or NSTEMI:

    <p>Unfractionated heparin = Preferred for patients in whom CABG is planned Low-molecular-weight heparins (LMWH) = Recommended for patients with unstable angina or NSTEMI Factor Xa inhibitors (e.g., fondaparinux) = Considered an option for antithrombin in patients with unstable angina or NSTEMI Direct thrombin inhibitors (e.g., bivalirudin) = Resistant to agents that degrade heparin</p> Signup and view all the answers

    Match the following anticoagulants with their use in patients undergoing PCI revascularization:

    <p>Unfractionated heparin = Option for patients undergoing PCI revascularization, in consultation with cardiology consultant Low-molecular-weight heparins (LMWH) = Option for patients undergoing PCI revascularization, in consultation with cardiology consultant Factor Xa inhibitors (e.g., fondaparinux) = May be considered for patients treated with non-fibrin specific thrombolytics such as streptokinase Direct thrombin inhibitors (e.g., bivalirudin) = Comparison with unfractionated heparin found no outcomes benefit</p> Signup and view all the answers

    Match the following anticoagulants with their use in STEMI patients lacking renal impairment:

    <p>Unfractionated heparin = May be considered for those patients treated with thrombolytics that are not fibrin specific such as streptokinase Low-molecular-weight heparins (LMWH) = Not specified for use in STEMI patients lacking renal impairment Factor Xa inhibitors (e.g., fondaparinux) = May be considered for those patients treated with thrombolytics that are not fibrin specific such as streptokinase Direct thrombin inhibitors (e.g., bivalirudin) = Not specified for use in STEMI patients lacking renal impairment</p> Signup and view all the answers

    Match the following anticoagulants with their resistance to agents that degrade heparin:

    <p>Unfractionated heparin = Not resistant to agents that degrade heparin Low-molecular-weight heparins (LMWH) = Not resistant to agents that degrade heparin Factor Xa inhibitors (e.g., fondaparinux) = Not resistant to agents that degrade heparin Direct thrombin inhibitors (e.g., bivalirudin) = Resistant to agents that degrade heparin</p> Signup and view all the answers

    Match the following antiplatelet agents with their use in emergency treatment of STEMI:

    <p>Aspirin = Loading dose of 162-325 mg followed by 75 mg/d Clopidogrel = Loading dose of 600 mg promptly and no more than 1 h after PCI once coronary anatomy is defined Prasugrel = Loading dose of 60 mg followed by 10 mg Ticagrelor = Loading dose of 180 mg followed by 90 mg twice a day</p> Signup and view all the answers

    Match the following antithrombins with their use in emergency treatment of STEMI:

    <p>Unfractionated heparin = Bolus of 60 U/kg (maximum, 4000 U) followed by infusion of 12 U/kg/h titrated to aPTT 1.5-2.5 × control Enoxaparin = 30 mg IV bolus followed by 1 mg/kg SC every 12 h Fondaparinux = 2.5 mg SC Bivalirudin = 0.75 mg/kg infused over next 30 min; 0.5 mg/kg infused over next 60 min</p> Signup and view all the answers

    Match the following fibrinolytic agents with their use in emergency treatment of STEMI:

    <p>Streptokinase = 1.5 MU over 60 min Anistreplase = Not listed in the given text Alteplase = Weight-based dosing Reteplase = Not listed in the given text</p> Signup and view all the answers

    Match the following glycoprotein IIb/IIIa inhibitors with their use in emergency treatment of STEMI:

    <h1>Abciximab = 10 U IV over 2 min followed by 10 U IV bolus 30 min later Eptifibatide = Weight-based dosing Tirofiban = Not listed in the given text</h1> Signup and view all the answers

    Match the following anti-ischemic therapies with their use in emergency treatment of STEMI:

    <h1>Nitroglycerin = Not listed in the given text Morphine = Not listed in the given text</h1> Signup and view all the answers

    Match the following adjunct therapies with their use for ongoing angina in ACS patients:

    <p>Fibrinolytic agents = Not recommended for ongoing angina in ACS patients Glycoprotein IIb/IIIa inhibitors = Not recommended for ongoing angina in ACS patients Nitroglycerin = May be considered for ongoing angina in ACS patients Morphine = Not recommended for ongoing angina in ACS patients</p> Signup and view all the answers

    Patients with ACS may present with atypical symptoms, such as shortness of breath or abdominal pain.

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

    Chest pain is the only symptom reported by patients with ACS.

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

    Patients with a long history of cocaine use are not at risk for accelerated CAD development.

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

    Important elements of the history for patients with ACS include the timing, location, quality, severity, and duration of chest pain.

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

    Recent cocaine use can cause acute ischemia from coronary vasospasm.

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

    Atypical symptoms of ACS can include dizziness and palpitations.

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

    The risk factors for CAD, such as older age and smoking, are not important in stratifying the risk of ACS.

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

    The most common symptom for patients with ACS is substernal or left-sided chest pain.

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

    Patients diagnosed with ACS may not report chest pain as their chief complaint.

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

    Nausea, vomiting, or diaphoresis are not associated with chest pain diagnosed as ACS.

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

    Unfractionated heparin is the preferred anticoagulant for patients in whom CABG is planned.

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

    Fondaparinux is considered an option as an antithrombin in patients with unstable angina or NSTEMI.

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

    Fondaparinux may be considered for STEMI patients treated with non-fibrin specific thrombolytics such as streptokinase.

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

    Direct thrombin inhibitors, such as bivalirudin, have been found to have better outcomes than unfractionated heparin.

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

    Aspirin, clopidogrel, and ticagrelor are all listed as antiplatelet agents used in the emergency treatment of STEMI.

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

    Enoxaparin is a factor Xa inhibitor.

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

    The loading dose of aspirin for emergency treatment of STEMI is 162–325 mg.

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

    Prasugrel has a loading dose of 180 mg followed by 90 mg twice a day for emergency treatment of STEMI.

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

    Abciximab, eptifibatide, and tirofiban are all listed as glycoprotein IIb/IIIa inhibitors used in the emergency treatment of STEMI.

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

    The recommended initial treatment for patients with suspected Acute Coronary Syndrome (ACS) includes administering a loading dose of 600 mg PO followed by 75 mg/d of clopidogrel.

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

    Risk factors alone are highly predictive of myocardial infarction in patients with acute symptoms

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

    Unstable angina is primarily diagnosed based on diagnostic testing

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

    Promptly obtaining an ECG is not essential to assess for signs of cardiac ischemia

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

    NSTEMI is diagnosed solely based on elevated serum troponin levels

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

    Acute Coronary Syndromes may present with symptoms resembling pulmonary embolism

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

    ST-segment elevations in specific locations are diagnostic for NSTEMI

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

    Clopidogrel is not recommended for use in patients with moderate to high-risk NSTEMI and STEMI

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

    Aspirin is not recommended as an initial treatment for patients with suspected ACS

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

    Administering nitroglycerin and morphine sulfate is not recommended as adjuncts for ongoing angina in ACS patients

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

    Unstable angina is not characterized by chest pain associated with evidence of obstructive coronary artery disease

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

    Study Notes

    Acute Coronary Syndromes: Diagnosis and Emergency Department Care

    • Risk factors alone are not highly predictive of myocardial infarction in patients with acute symptoms
    • Physical examination can help identify signs of hemodynamic dysfunction from cardiac strain or acute heart failure
    • Alternative diagnoses for patient symptoms may include pulmonary embolism, congestive heart failure, and others
    • Promptly obtaining an ECG is essential to assess for signs of cardiac ischemia
    • Findings diagnostic for STEMI include specific criteria for ST-segment elevations in different locations
    • NSTEMI is diagnosed when an elevated serum troponin is identified in a patient with symptoms consistent with myocardial ischemia
    • Unstable angina is a clinical diagnosis based on history, physical examination findings, and diagnostic testing
    • Unstable angina characteristically presents with chest pain associated with evidence of obstructive coronary artery disease
    • STEMI treatment includes reperfusion by reducing thrombus, limiting thrombus extension, and relieving obstructive CAD
    • For patients with a suspected ACS, begin cardiac monitoring, place an intravenous line, and provide supplemental oxygen if necessary
    • Administer aspirin, consider nitroglycerin and morphine sulfate as adjuncts for ongoing angina
    • Clopidogrel is recommended for use along with aspirin for patients with moderate to high-risk NSTEMI and STEMI

    Acute Coronary Syndromes: Diagnosis and Emergency Department Care

    • Risk factors alone are not highly predictive of myocardial infarction in patients with acute symptoms
    • Physical examination can help identify signs of hemodynamic dysfunction from cardiac strain or acute heart failure
    • Alternative diagnoses for patient symptoms may include pulmonary embolism, congestive heart failure, and others
    • Promptly obtaining an ECG is essential to assess for signs of cardiac ischemia
    • Findings diagnostic for STEMI include specific criteria for ST-segment elevations in different locations
    • NSTEMI is diagnosed when an elevated serum troponin is identified in a patient with symptoms consistent with myocardial ischemia
    • Unstable angina is a clinical diagnosis based on history, physical examination findings, and diagnostic testing
    • Unstable angina characteristically presents with chest pain associated with evidence of obstructive coronary artery disease
    • STEMI treatment includes reperfusion by reducing thrombus, limiting thrombus extension, and relieving obstructive CAD
    • For patients with a suspected ACS, begin cardiac monitoring, place an intravenous line, and provide supplemental oxygen if necessary
    • Administer aspirin, consider nitroglycerin and morphine sulfate as adjuncts for ongoing angina
    • Clopidogrel is recommended for use along with aspirin for patients with moderate to high-risk NSTEMI and STEMI

    Acute Coronary Syndromes: Diagnosis and Emergency Department Care

    • Risk factors alone are not highly predictive of myocardial infarction in patients with acute symptoms
    • Physical examination can help identify signs of hemodynamic dysfunction from cardiac strain or acute heart failure
    • Alternative diagnoses for patient symptoms may include pulmonary embolism, congestive heart failure, and others
    • Promptly obtaining an ECG is essential to assess for signs of cardiac ischemia
    • Findings diagnostic for STEMI include specific criteria for ST-segment elevations in different locations
    • NSTEMI is diagnosed when an elevated serum troponin is identified in a patient with symptoms consistent with myocardial ischemia
    • Unstable angina is a clinical diagnosis based on history, physical examination findings, and diagnostic testing
    • Unstable angina characteristically presents with chest pain associated with evidence of obstructive coronary artery disease
    • STEMI treatment includes reperfusion by reducing thrombus, limiting thrombus extension, and relieving obstructive CAD
    • For patients with a suspected ACS, begin cardiac monitoring, place an intravenous line, and provide supplemental oxygen if necessary
    • Administer aspirin, consider nitroglycerin and morphine sulfate as adjuncts for ongoing angina
    • Clopidogrel is recommended for use along with aspirin for patients with moderate to high-risk NSTEMI and STEMI

    Acute Coronary Syndromes: Diagnosis and Emergency Department Care

    • Risk factors alone are not highly predictive of myocardial infarction in patients with acute symptoms
    • Physical examination can help identify signs of hemodynamic dysfunction from cardiac strain or acute heart failure
    • Alternative diagnoses for patient symptoms may include pulmonary embolism, congestive heart failure, and others
    • Promptly obtaining an ECG is essential to assess for signs of cardiac ischemia
    • Findings diagnostic for STEMI include specific criteria for ST-segment elevations in different locations
    • NSTEMI is diagnosed when an elevated serum troponin is identified in a patient with symptoms consistent with myocardial ischemia
    • Unstable angina is a clinical diagnosis based on history, physical examination findings, and diagnostic testing
    • Unstable angina characteristically presents with chest pain associated with evidence of obstructive coronary artery disease
    • STEMI treatment includes reperfusion by reducing thrombus, limiting thrombus extension, and relieving obstructive CAD
    • For patients with a suspected ACS, begin cardiac monitoring, place an intravenous line, and provide supplemental oxygen if necessary
    • Administer aspirin, consider nitroglycerin and morphine sulfate as adjuncts for ongoing angina
    • Clopidogrel is recommended for use along with aspirin for patients with moderate to high-risk NSTEMI and STEMI

    Acute Coronary Syndromes: Diagnosis and Emergency Department Care

    • Risk factors alone are not highly predictive of myocardial infarction in patients with acute symptoms
    • Physical examination can help identify signs of hemodynamic dysfunction from cardiac strain or acute heart failure
    • Alternative diagnoses for patient symptoms may include pulmonary embolism, congestive heart failure, and others
    • Promptly obtaining an ECG is essential to assess for signs of cardiac ischemia
    • Findings diagnostic for STEMI include specific criteria for ST-segment elevations in different locations
    • NSTEMI is diagnosed when an elevated serum troponin is identified in a patient with symptoms consistent with myocardial ischemia
    • Unstable angina is a clinical diagnosis based on history, physical examination findings, and diagnostic testing
    • Unstable angina characteristically presents with chest pain associated with evidence of obstructive coronary artery disease
    • STEMI treatment includes reperfusion by reducing thrombus, limiting thrombus extension, and relieving obstructive CAD
    • For patients with a suspected ACS, begin cardiac monitoring, place an intravenous line, and provide supplemental oxygen if necessary
    • Administer aspirin, consider nitroglycerin and morphine sulfate as adjuncts for ongoing angina
    • Clopidogrel is recommended for use along with aspirin for patients with moderate to high-risk NSTEMI and STEMI

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    Test your knowledge of acute coronary syndromes, including diagnosis and emergency department care. Challenge yourself with questions about risk factors, diagnostic tests, treatment options, and alternative diagnoses for patients with symptoms of myocardial infarction and unstable angina.

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