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Questions and Answers
What condition is characterized by inadequate supply of blood and oxygen to a portion of the myocardium?
What condition is characterized by inadequate supply of blood and oxygen to a portion of the myocardium?
Which risk factor is classified as non-modifiable?
Which risk factor is classified as non-modifiable?
Which clinical feature is characteristic of acute coronary syndrome?
Which clinical feature is characteristic of acute coronary syndrome?
What is the primary goal of treatment for acute coronary syndrome?
What is the primary goal of treatment for acute coronary syndrome?
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Which of the following is a common risk factor for acute coronary syndrome?
Which of the following is a common risk factor for acute coronary syndrome?
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What is the most common spectrum of acute coronary syndrome?
What is the most common spectrum of acute coronary syndrome?
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What does the TIMI Score evaluate in patients?
What does the TIMI Score evaluate in patients?
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Which biomarker is primarily used to diagnose myocardial infarction?
Which biomarker is primarily used to diagnose myocardial infarction?
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Which condition is indicated by the rupture of an atherosclerotic plaque in coronary arteries?
Which condition is indicated by the rupture of an atherosclerotic plaque in coronary arteries?
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How long does Cardiac Troponin I typically remain elevated after a myocardial infarction?
How long does Cardiac Troponin I typically remain elevated after a myocardial infarction?
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What does an echocardiogram primarily assess in patients with ischemic heart disease?
What does an echocardiogram primarily assess in patients with ischemic heart disease?
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At what age is the risk for ischemic heart disease significantly increased?
At what age is the risk for ischemic heart disease significantly increased?
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Which of the following is NOT a clinical feature associated with ischemic heart disease?
Which of the following is NOT a clinical feature associated with ischemic heart disease?
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Which medication should be used with caution in patients with a systolic blood pressure below 90 mm Hg?
Which medication should be used with caution in patients with a systolic blood pressure below 90 mm Hg?
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What is the main goal of managing patients with CAD?
What is the main goal of managing patients with CAD?
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Which of the following therapies is recommended for all patients with ACS without contraindications?
Which of the following therapies is recommended for all patients with ACS without contraindications?
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What is the recommended action for NSTE-ACS patients based on their risk level?
What is the recommended action for NSTE-ACS patients based on their risk level?
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In which case are calcium channel blockers recommended?
In which case are calcium channel blockers recommended?
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What is the primary purpose of administering oxygen to a patient with ACS?
What is the primary purpose of administering oxygen to a patient with ACS?
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Which treatment is NOT effective for improving survival or preventing MACE in patients with ACS?
Which treatment is NOT effective for improving survival or preventing MACE in patients with ACS?
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What is a characteristic of β-blockers in the management of ACS?
What is a characteristic of β-blockers in the management of ACS?
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What is the initial IV bolus dose of Metoprolol for acute supportive care?
What is the initial IV bolus dose of Metoprolol for acute supportive care?
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Which of the following beta-blockers requires an initial IV therapy that may be omitted?
Which of the following beta-blockers requires an initial IV therapy that may be omitted?
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What is the maximum total IV dose for Alteplase in fibrinolytic therapy?
What is the maximum total IV dose for Alteplase in fibrinolytic therapy?
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For which condition is primary percutaneous coronary intervention (PCI) preferred?
For which condition is primary percutaneous coronary intervention (PCI) preferred?
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What dose of Esmolol may be given as an optional loading dose?
What dose of Esmolol may be given as an optional loading dose?
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What is the appropriate dose range for Reteplase in fibrinolytic therapy?
What is the appropriate dose range for Reteplase in fibrinolytic therapy?
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Tenecteplase is administered as what type of dosage?
Tenecteplase is administered as what type of dosage?
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Which of the following statements about beta-blockers is false?
Which of the following statements about beta-blockers is false?
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Study Notes
Ischemic Heart Disease
- Ischemic heart disease occurs when there is insufficient blood and oxygen supply to a portion of the myocardium.
- Atherosclerosis plaque rupture and thrombus formation in the coronary arteries are the primary causes of ischemic heart disease.
Acute Coronary Syndrome
- A group of potentially life-threatening conditions resulting from a thrombus formation in the coronary arteries.
Risk Factors for Plaque Formation
- Hypertension
- BMI over 30
- Alcohol consumption
- Age over 65
- Increased LDL levels
- Diabetes
- Family history of coronary artery disease
- Tobacco use
Categories of Ischemic Heart Disease: Clinical Features
- Substernal chest pain described as “squeezing, tight choking.”
- Chest pain occurring with exertion and can disappear with rest.
Categories of Ischemic Heart Disease: ACS - Clinical Features
- Chest pain occurring at rest and worsens with exertion.
Right Ventricular Myocardial Infarction vs Left Ventricular Myocardial Infarction
- Right ventricular MI: Mostly affects the right ventricle.
- Left ventricular MI: Involves the left ventricle.
Complications of Ischemic Heart Disease
- First 24 hours: Arrhythmias (ventricular fibrillation, atrial fibrillation), cardiogenic shock, heart failure.
- 24 hours to 3 days: Pericarditis, papillary muscle rupture, mitral valve regurgitation.
- 3 days to 14 days: Ventricular aneurysm, mural thrombus formation.
- 14 days to 1 month: Dressler's syndrome, late ventricular rupture.
Diagnosis: EKG & Biomarker
- Electrocardiogram (EKG): Used to identify ST-segment elevation (STEMI) or ST-depression (NSTEMI).
- Biomarkers: Troponin I (elevated levels indicate myocardial damage), creatine kinase (CK), and creatine kinase MB (CK-MB) are common biomarkers used.
Diagnostic Feature: Cardiac Troponin I
- Levels rise 2-4 hours after myocardial injury.
- Peak levels are reached in 12-48 hours.
- Remains elevated for 4-15 days.
Diagnostic Feature: Coronary Angiography
- Visualizes coronary arteries to identify blockages.
Diagnostic Feature: Echocardiogram
- Uses sound waves to image the heart and determine the extent of damage.
TIMI Score
- Used to stratify patients with NSTEMI or unstable angina and determine the need for catheterization based on the risk of mortality.
Stress Testing
- Pharmacologic Stress Testing: Uses medication to simulate exercise and evaluate heart function.
- Exercise Stress Testing: Evaluates heart function during exercise.
Epidemiology of Acute Coronary Syndrome
- Prevalent in males (67%) with a median age of 61 years.
- Common risk factors include hypertension (77.1%), diabetes (39%), and smoking history (33.4%).
Risk Factors for ACS
- Non-modifiable risk factors: Aging, male sex, family history, genetic predisposition, ethnicity (Caucasians).
- Modifiable risk factors: Smoking, hypertension, poor diet, dyslipidemia, obesity, sedentary lifestyle, diabetes.
Goal of Treatment for Acute Coronary Syndrome
- Short-term goals: Restoration of blood flow to the affected artery, prevention of infarct expansion (in case of MI), prevention of death and complications, prevention of coronary artery reocclusion, relief of ischemic chest discomfort.
- Long-term goals: Control of CAD risk factors, prevention of additional MACE (major adverse cardiac events), improvement in quality of life.
General Approach to Treatment
- Patients with STEMI require urgent PCI to restore blood flow.
- Patients with NSTEMI may need PCI or medical management based on their risk level.
- All patients must receive antithrombotic therapy, pain relief, and medication to prevent MACE and complications.
Acute Supportive Care: MONA
- Morphine: Relief of pain
- Oxygen: Improves oxygen delivery to the heart.
- Nitrate: Reduces chest pain and workload of the heart.
- Aspirin: Prevents further clot formation.
Acute Supportive Care: THROMBINS2
- Thienopyridine: Antiplatelet therapy.
- Heparin: Prevents clot formation.
- RAAS inhibitors: Reduce blood pressure and workload of the heart.
- Oxygen: Improves oxygen delivery.
- Morphine: Pain relief.
- Beta-blocker: Reduces heart rate and workload.
- Percutaneous Coronary Intervention (PCI): To open blocked coronary arteries.
- Nitroglycerin (NTG): Dilates coronary arteries.
- Statins & Salicylates: Reduce cholesterol levels and prevent further clot formation.
Acute Supportive Care: Beta-blockers
- Metoprolol, Propranolol, Atenolol, Esmolol: Reduce heart rate and workload of the heart.
Acute Supportive Care: Calcium Channel Blockers (CCBs)
- Non-dihydrophyridine (non-DHP) CCBs: Reduce heart rate and workload.
- Dihydropyridine (DHP) CCBs: Can cause harm and should be avoided in ACS.
Management Strategies for STEMI
- Primary percutaneous coronary intervention (PCI): Preferred for patients with cardiogenic shock, increased bleeding risk, or symptoms present for at least 2-3 hours.
- Fibrinolytic therapy: Uses medications like alteplase, reteplase, or tenecteplase to dissolve clots.
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Description
This quiz delves into ischemic heart disease, its causes, and clinical features. It covers topics such as acute coronary syndrome and risk factors for plaque formation. Test your knowledge on the key aspects of this serious condition.
