139 Questions
Which symptom is most common for patients with Acute Coronary Syndromes (ACS)?
Chest pain
What are important elements to consider in the history of patients with ACS?
Timing of symptom onset, location, quality, severity, and duration
Which risk factor is associated with accelerated coronary artery disease (CAD) development?
Long history of cocaine use
What percentage of patients diagnosed with ACS report atypical symptoms?
20% to 30%
Which of the following is not a typical atypical symptom of ACS?
Cough
What is a clinical feature associated with chest pain diagnosed as ACS?
Radiation of pain to one or both arms
What should be discussed with patients to stratify the risk of ACS?
Risk factors for coronary artery disease (CAD)
What is a risk factor for coronary artery disease (CAD) that can lead to ACS?
Hypertension
What type of chest pain is associated with ACS?
Substernal or left-sided chest pain
What can recent cocaine use cause in relation to ACS?
Acute ischemia from coronary vasospasm
Which anticoagulant is preferred for patients in whom CABG is planned?
Unfractionated heparin
Which antithrombin is considered an option for patients with unstable angina or NSTEMI?
Fondaparinux
Which anticoagulant may be considered for STEMI patients lacking renal impairment and treated with non-fibrin specific thrombolytics?
Fondaparinux
Which direct thrombin inhibitor is resistant to agents that degrade heparin?
Bivalirudin
Which antiplatelet agent is not listed in the given text?
Ticlopidine
Which fibrinolytic agent is not listed in the given text?
Rituximab
What is the loading dose of aspirin for emergency treatment of STEMI?
600 mg
What is the loading dose of clopidogrel for emergency treatment of STEMI?
600 mg
What is the loading dose of prasugrel for emergency treatment of STEMI?
162 mg
What is the loading dose of ticagrelor for emergency treatment of STEMI?
325 mg
What is the essential initial step for assessing signs of cardiac ischemia in patients with acute symptoms?
Promptly obtaining an ECG
Which finding is diagnostic for ST-segment elevation myocardial infarction (STEMI)?
Specific criteria for ST-segment elevations in different locations
How is non-ST-segment elevation myocardial infarction (NSTEMI) diagnosed?
By identifying elevated serum troponin in a patient with symptoms consistent with myocardial ischemia
What is the characteristic presentation of unstable angina?
Chest pain associated with evidence of obstructive coronary artery disease
What is the recommended initial treatment for patients with suspected Acute Coronary Syndrome (ACS)?
Administer aspirin, consider nitroglycerin and morphine sulfate
What is the primary goal of STEMI treatment?
Reducing thrombus, limiting thrombus extension, and relieving obstructive CAD
When is clopidogrel recommended for use in patients with ACS?
For patients with moderate to high-risk NSTEMI and STEMI
What adjunct therapy may be considered for ongoing angina in ACS patients?
Nitroglycerin and morphine sulfate
What can physical examination help identify in patients with acute symptoms?
Signs of hemodynamic dysfunction from cardiac strain or acute heart failure
What is the role of risk factors in predicting myocardial infarction in patients with acute symptoms?
Not highly predictive of myocardial infarction
What percentage of patients diagnosed with ACS report atypical symptoms?
20% to 30%
Which of the following is a risk factor for accelerated coronary artery disease (CAD) development?
Long history of cocaine use
What is a key clinical feature associated with chest pain diagnosed as ACS?
Radiation of pain to one or both arms
Which risk factor should be discussed with patients to stratify the risk of ACS?
Hypertension
What is a symptom commonly reported by patients with ACS?
Shortness of breath
What is a characteristic presentation of unstable angina?
Chest pain at rest
Which of the following is a risk factor for coronary artery disease (CAD) that can lead to ACS?
Hypertension
What are important elements to consider in the history of patients with ACS?
Timing of symptom onset, location, quality, severity, and duration
What adjunct therapy may be considered for ongoing angina in ACS patients?
Nitroglycerin
What is the primary goal of STEMI treatment?
Restoration of blood flow to the heart muscle
Which anticoagulant is preferred for patients in whom CABG is planned?
Unfractionated heparin
Which antithrombin is considered an option for patients with unstable angina or NSTEMI?
Fondaparinux
Which direct thrombin inhibitor is resistant to agents that degrade heparin?
Bivalirudin
What is the loading dose of Ticagrelor for emergency treatment of STEMI?
180 mg
What is the loading dose of ticagrelor for emergency treatment of STEMI?
60 mg
What adjunct therapy may be considered for ongoing angina in ACS patients?
Glycoprotein IIb/IIIa Inhibitors
What percentage of patients diagnosed with ACS report atypical symptoms?
50%
What is the role of risk factors in predicting myocardial infarction in patients with acute symptoms?
They help to stratify the risk of myocardial infarction
What can recent cocaine use cause in relation to ACS?
Increased risk of ACS
What is the diagnostic criteria for NSTEMI?
Elevated serum troponin and symptoms consistent with myocardial ischemia
What is the characteristic presentation of unstable angina?
Chest pain associated with evidence of obstructive coronary artery disease
What is the primary goal of STEMI treatment?
Reperfusion by reducing thrombus, limiting thrombus extension, and relieving obstructive CAD
What is the initial step for assessing signs of cardiac ischemia in patients with acute symptoms?
Promptly obtaining an ECG
Which adjunct therapy may be considered for ongoing angina in ACS patients?
Nitroglycerin and morphine sulfate
When is clopidogrel recommended for use in patients with moderate to high-risk NSTEMI and STEMI?
Along with aspirin
What is the role of risk factors in predicting myocardial infarction in patients with acute symptoms?
Risk factors alone are not highly predictive of myocardial infarction
What is the recommended initial treatment for patients with suspected Acute Coronary Syndrome (ACS)?
Begin cardiac monitoring, place an intravenous line, and provide supplemental oxygen if necessary
Which anticoagulant may be considered for STEMI patients lacking renal impairment and treated with non-fibrin specific thrombolytics?
Heparin
What adjunct therapy is recommended for ongoing angina in ACS patients?
Nitroglycerin and morphine sulfate
Which anticoagulant is preferred for patients in whom CABG is planned?
Unfractionated heparin
What is the loading dose of ticagrelor for emergency treatment of STEMI?
180 mg
Which direct thrombin inhibitor is resistant to agents that degrade heparin?
Bivalirudin
What is the role of risk factors in predicting myocardial infarction in patients with acute symptoms?
They assist in stratifying the risk of ACS
When is clopidogrel recommended for use in patients with moderate to high-risk NSTEMI and STEMI?
As an adjunct therapy to aspirin
What is the loading dose of prasugrel for emergency treatment of STEMI?
60 mg
Which antiplatelet agent is not listed in the given text?
Ticlopidine
What adjunct therapy may be considered for ongoing angina in ACS patients?
Nitroglycerin
Which antiplatelet agent has a loading dose of 600 mg PO followed by 75 mg/d?
Clopidogrel
What is the loading dose of clopidogrel for emergency treatment of STEMI?
75 mg
What is the percentage of patients diagnosed with ACS that report atypical symptoms?
20%-30%
What is the recommended initial treatment for patients with suspected Acute Coronary Syndrome (ACS)?
Aspirin and oxygen therapy
Which risk factor is associated with accelerated coronary artery disease (CAD) development?
Cocaine use
What is the role of risk factors in predicting myocardial infarction in patients with acute symptoms?
Major role
Which of the following is a diagnostic criterion for ST-segment elevation myocardial infarction (STEMI)?
Presence of Q waves on ECG
What adjunct therapy may be considered for ongoing angina in ACS patients?
Beta-blockers
What is the recommended initial treatment for patients with suspected Acute Coronary Syndrome (ACS)?
Cardiac monitoring and supplemental oxygen if necessary
Which anticoagulant is preferred for patients in whom CABG is planned?
Bivalirudin
Which adjunct therapy may be considered for ongoing angina in ACS patients?
Intravenous nitroglycerin
What can recent cocaine use cause in relation to ACS?
Arrhythmias
What is the characteristic presentation of unstable angina?
Chest pain with evidence of obstructive coronary artery disease
What is the characteristic presentation of unstable angina?
Chest pain relieved by rest or nitroglycerin
When is clopidogrel recommended for use in patients with moderate to high-risk NSTEMI and STEMI?
As an adjunct to aspirin therapy
What adjunct therapy is recommended for ongoing angina in ACS patients?
Platelet glycoprotein IIb/IIIa inhibitors
What is the primary goal of STEMI treatment?
Reperfusion and relieving obstructive CAD
What should be discussed with patients to stratify the risk of ACS?
Risk factors for coronary artery disease (CAD)
How is non-ST-segment elevation myocardial infarction (NSTEMI) diagnosed?
Elevated serum troponin with symptoms consistent with myocardial ischemia
Which anticoagulant is considered an option for patients with unstable angina or NSTEMI?
Heparin
What can recent cocaine use cause in relation to ACS?
Increased risk of vasospasm-induced angina
Which antithrombin is considered an option for patients with unstable angina or NSTEMI?
Enoxaparin
Match the following clinical features with their association with chest pain in ACS:
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
Match the following risk factors for coronary artery disease (CAD) with their association with ACS:
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
Match the following atypical symptoms with their association in ACS diagnosis:
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
Match the following risk factors for coronary artery disease (CAD) with their association with ACS:
Male gender = Risk factor for ACS Family history = Risk factor for ACS Hypertension = Risk factor for ACS Diabetes = Risk factor for ACS
Match the following risk factors for coronary artery disease (CAD) with their association with ACS:
Family history = Risk factor for ACS Hypertension = Risk factor for ACS Diabetes = Risk factor for ACS NSTEMI = Atypical risk factor for ACS
Match the following diagnostic tool with its essential role in ACS diagnosis:
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
Match the following diagnoses with the alternative conditions for patient symptoms:
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
Match the following ACS types with their diagnostic criteria:
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
Match the following treatment options with their respective use in ACS management:
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
Match the following initial management steps with their recommended actions for patients with suspected ACS:
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
Match the following anticoagulants with their recommended use in patients with unstable angina or NSTEMI:
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
Match the following anticoagulants with their use in patients undergoing PCI revascularization:
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
Match the following anticoagulants with their use in STEMI patients lacking renal impairment:
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
Match the following anticoagulants with their resistance to agents that degrade heparin:
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
Match the following antiplatelet agents with their use in emergency treatment of STEMI:
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
Match the following antithrombins with their use in emergency treatment of STEMI:
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
Match the following fibrinolytic agents with their use in emergency treatment of STEMI:
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
Match the following glycoprotein IIb/IIIa inhibitors with their use in emergency treatment of STEMI:
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
Match the following anti-ischemic therapies with their use in emergency treatment of STEMI:
Nitroglycerin = Not listed in the given text Morphine = Not listed in the given text
Match the following adjunct therapies with their use for ongoing angina in ACS patients:
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
Patients with ACS may present with atypical symptoms, such as shortness of breath or abdominal pain.
True
Chest pain is the only symptom reported by patients with ACS.
False
Patients with a long history of cocaine use are not at risk for accelerated CAD development.
False
Important elements of the history for patients with ACS include the timing, location, quality, severity, and duration of chest pain.
True
Recent cocaine use can cause acute ischemia from coronary vasospasm.
True
Atypical symptoms of ACS can include dizziness and palpitations.
True
The risk factors for CAD, such as older age and smoking, are not important in stratifying the risk of ACS.
False
The most common symptom for patients with ACS is substernal or left-sided chest pain.
True
Patients diagnosed with ACS may not report chest pain as their chief complaint.
True
Nausea, vomiting, or diaphoresis are not associated with chest pain diagnosed as ACS.
False
Unfractionated heparin is the preferred anticoagulant for patients in whom CABG is planned.
True
Fondaparinux is considered an option as an antithrombin in patients with unstable angina or NSTEMI.
True
Fondaparinux may be considered for STEMI patients treated with non-fibrin specific thrombolytics such as streptokinase.
True
Direct thrombin inhibitors, such as bivalirudin, have been found to have better outcomes than unfractionated heparin.
False
Aspirin, clopidogrel, and ticagrelor are all listed as antiplatelet agents used in the emergency treatment of STEMI.
True
Enoxaparin is a factor Xa inhibitor.
False
The loading dose of aspirin for emergency treatment of STEMI is 162–325 mg.
True
Prasugrel has a loading dose of 180 mg followed by 90 mg twice a day for emergency treatment of STEMI.
False
Abciximab, eptifibatide, and tirofiban are all listed as glycoprotein IIb/IIIa inhibitors used in the emergency treatment of STEMI.
True
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.
False
Risk factors alone are highly predictive of myocardial infarction in patients with acute symptoms
False
Unstable angina is primarily diagnosed based on diagnostic testing
False
Promptly obtaining an ECG is not essential to assess for signs of cardiac ischemia
False
NSTEMI is diagnosed solely based on elevated serum troponin levels
False
Acute Coronary Syndromes may present with symptoms resembling pulmonary embolism
True
ST-segment elevations in specific locations are diagnostic for NSTEMI
False
Clopidogrel is not recommended for use in patients with moderate to high-risk NSTEMI and STEMI
False
Aspirin is not recommended as an initial treatment for patients with suspected ACS
False
Administering nitroglycerin and morphine sulfate is not recommended as adjuncts for ongoing angina in ACS patients
False
Unstable angina is not characterized by chest pain associated with evidence of obstructive coronary artery disease
False
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
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.
Make Your Own Quizzes and Flashcards
Convert your notes into interactive study material.
Get started for free
