117 Questions
What is the recommended therapy for reducing infarct size in patients with ACS?
B-blockers
When is thrombolytic therapy recommended for patients with NSTE ACS?
Not recommended
What should all patients presenting with ACS receive?
A loading dose of aspirin
What therapy is not recommended for patients with NSTE ACS?
Thrombolytic therapy
What should all patients presenting with ACS receive as a loading dose?
Aspirin
What therapy is recommended to reduce infarct size in patients with ACS?
B-blockers
What is the recommended daily dose of aspirin for patients with ACS after the initial administration?
81 to 162 mg
In which patients is prasugrel indicated?
Patients treated with PCI
When is clopidogrel or ticagrelor therapy recommended after ACS presentation?
For 1 year
When are intravenous glycoprotein IIb/IIIa inhibitors generally reserved for use?
During PCI in patients with evident thrombus at the time of coronary angiography and intervention
What is the recommended daily maintenance dose of aspirin for patients with ACS?
81 to 162 mg
In which patients is prasugrel indicated?
Patients treated with PCI
When is early clopidogrel loading recommended for patients with ACS?
Regardless of reperfusion or revascularization strategy
When is intravenous glycoprotein IIb/IIIa inhibitors administration associated with lack of benefit and increased bleeding risk?
In patients tolerant of DAPT in the emergency department
What anticoagulant is favored over enoxaparin for patients undergoing PCI, especially those with kidney dysfunction?
Unfractionated heparin
What anticoagulant is associated with reduced reocclusion of the infarct related artery and improved outcomes in patients receiving thrombolytic therapy?
Enoxaparin
For how long is anticoagulation recommended in medically treated patients presenting with ACS?
At least 48 hours and generally continued until discharge
What is the preferred anticoagulant for patients undergoing PCI, especially those with kidney dysfunction?
Unfractionated heparin
Which anticoagulant is associated with reduced reocclusion of the infarct related artery and improved outcomes in patients receiving thrombolytic therapy?
Unfractionated heparin
When is fondaparinux not indicated during PCI for ACS?
Risk for procedural thrombosis
What is the recommended oxygen saturation level for initiating oxygen therapy in ACS patients?
90% to 92%
When should B-blockers be administered in ACS patients?
Orally within 24 hours of presentation
What is the primary purpose of using nitrates in ACS?
Manage angina symptoms
When is intravenous nitroglycerin recommended for ACS patients?
For patients with persistent chest pain despite B-blockade
What is the recommended oxygen saturation level for initiating oxygen therapy in ACS patients?
Less than 90% to 92%
When should B-blockers be administered in ACS patients?
Orally within 24 hours of presentation
What is the primary purpose of using nitrates in ACS?
To manage angina symptoms and relieve chest pain
When is intravenous nitroglycerin recommended for ACS patients?
For patients with persistent chest pain despite B-blockade
What is the recommended therapy for reducing infarct size in patients with ACS?
Early statin therapy
When should eplerenone, an aldosterone antagonist, be initiated in patients with STEMI?
Within 1 week of presentation
What is the primary indication for using ARBs in patients with ACS?
Intolerance to ACE inhibitors
What is the recommended timing for administering high-intensity statin therapy in ACS patients?
Initiating in the inpatient setting
Which medication has been associated with lower rates of periprocedural MI when preloaded before PCI?
Eplerenone
In the absence of contraindications, when should ACE inhibitors be administered in patients with ACS?
Within 24 hours of presentation
For which patients with ACS is eplerenone beneficial when initiated within 1 week of presentation?
Patients with ejection fraction of 40% or less and either heart failure or diabetes
In which patients are ARBs indicated in the absence of ACE inhibitor tolerance?
Patients with diabetes
What is the recommended duration for dual antiplatelet therapy after acute coronary syndrome (ACS)?
1 year
In which patients is prasugrel indicated for use in ACS?
Patients treated with percutaneous coronary intervention
When are B-Blockers contraindicated in patients with acute coronary syndrome?
In patients with high-grade atrioventricular block
What is the recommended duration for dual antiplatelet therapy after acute coronary syndrome (ACS)?
1 year
When should B-blockers be avoided in patients with acute coronary syndrome?
During cardiogenic shock
Which medication may be used only in patients treated with percutaneous coronary intervention (PCI) for ACS?
Prasugrel
What is the common cause of chest pain among younger women who present with ACS and in the peripartum period?
Spontaneous coronary artery dissection (SCAD)
What is the pathophysiology of SCAD?
Involves development of a nontraumatic and non iatrogenic intramural hematoma with or without intimal dissection with luminal communication
How is diagnosis of SCAD confirmed?
By invasive or noninvasive angiography, using care to minimize unnecessary radiation exposure
When associated with STEMI, how may SCAD be managed?
Invasively
Which condition involves MI in the absence of obstructive CAD?
Spontaneous coronary artery dissection (SCAD)
What is the common cause of chest pain among younger women who present with ACS and in the peripartum period?
Spontaneous coronary artery dissection (SCAD)
How is diagnosis of Spontaneous coronary artery dissection (SCAD) confirmed?
High index of suspicion and confirmation by invasive or noninvasive angiography
When associated with STEMI, how may Spontaneous coronary artery dissection (SCAD) be managed?
Invasively
Which of the following is a common trigger for spontaneous coronary vasospasm?
Illicit substances
How is coronary vasospasm typically diagnosed?
Coronary angiography
What is the empirical treatment for patients suspected of having vasospasm or microvascular endothelial dysfunction?
Nitrates and/or calcium channel blockers
What is the primary diagnostic method for excluding fixed disease in patients suspected of having coronary vasospasm?
Coronary angiography
Which drugs are commonly associated with triggering spontaneous coronary vasospasm?
Methamphetamines and bromocriptine
What is the empirical treatment often used for patients suspected of having vasospasm or microvascular endothelial dysfunction?
Nitrates and calcium channel blockers
What is the recommended duration for dual antiplatelet therapy after an acute coronary syndrome (ACS)?
1 year
When should implantable cardioverter defibrillator placement be avoided for primary prevention after myocardial infarction?
Within 40 days of infarction
For which patients is nonstatin drug therapy considered beneficial in addition to maximally tolerated statin therapy?
Patients with a history of one major ASCVD event and multiple high risk conditions
When is aspirin therapy recommended to be continued indefinitely for patients with ACS?
Preferably 81 mg/d
What is the recommended duration for dual antiplatelet therapy (DAPT) after an acute coronary syndrome (ACS)?
At least 1 year
In patients at risk for sudden cardiac death after MI, when is implantable cardioverter defibrillator (ICD) placement not recommended for primary prevention?
Within 40 days of infarction
Who are judged to be at very high risk for recurrent ASCVD events and may benefit from the addition of nonstatin drug therapy to maximally tolerated statin therapy?
Patients with a history of multiple major ASCVD events or one major ASCVD event and multiple high-risk conditions
In patients with ACS, when are NSAIDs recommended to be avoided?
If possible, due to the increased cardiovascular risk associated with these drugs
What is the primary benefit of referring patients with ACS for cardiac rehabilitation?
Improving functional capacity and reducing mortality
What is a key outcome of medically observed exercise programs for patients with ACS?
Reduced mortality
What is the purpose of cardiac rehabilitation for patients with ACS?
To improve overall health and reduce mortality
What is a primary benefit of cardiac rehabilitation for patients with ACS?
Reduction in mortality
What is a key outcome of medically observed exercise programs for patients with ACS?
Reduced mortality
In addition to reducing mortality, what else does cardiac rehabilitation aim to improve for patients with ACS?
Risk factor profiles
What is the current status of guideline recommendations for evaluating patients with silent myocardial ischemia?
Guideline recommendations for evaluating patients with silent myocardial ischemia do not exist
What is the prognosis for patients with silent myocardial ischemia, especially those with known underlying heart disease?
They have a worse prognosis compared to those without underlying heart disease
What has led to an increasing recognition of silent myocardial ischemia?
Diagnostic chest imaging and dedicated coronary artery calcium scoring studies
What is the current status of guideline recommendations for evaluating patients with silent myocardial ischemia?
There are no guideline recommendations for evaluating patients with silent myocardial ischemia
What is the primary diagnostic method for excluding fixed disease in patients suspected of having coronary vasospasm?
Coronary angiography
What is the impact of silent myocardial ischemia on the prognosis of patients with known underlying heart disease?
It worsens the prognosis
What is a contributing factor to the under-treatment of older adults with cardiovascular disease?
Perceived heightened risk for adverse therapeutic response
Why are invasive angiography and revascularization used less often in older adults?
Higher procedural morbidity and mortality
What remains an essential element of risk reduction in all age groups?
Exercise, diet, and healthy lifestyle choices
What has been associated with adverse outcomes in the elderly according to recent meta-analysis?
Hyperlipidemia
Why are older adults often not treated with recognized secondary prevention therapies for cardiovascular disease?
Due to a perceived heightened risk for adverse therapeutic response compounded by the lack of outcome data in these patients
Why is exercise stress testing often limited or prohibited for prognostic and diagnostic purposes in older adults?
Comorbid conditions, loss of muscle mass, and gait abnormalities
What remains essential for risk reduction in all age groups, regardless of age?
Exercise, diet, and healthy lifestyle choices
What has a recent meta-analysis demonstrated about hyperlipidemia in the elderly?
Reduction in cardiac events and disability
What is a predominant cause of symptoms in women with typical angina symptoms and nonobstructive coronary stenoses?
Microvascular dysfunction
What is the predominant symptom in women with acute MI, although they can also have atypical symptoms?
Chest pain or pressure
Which unique manifestations of cardiovascular disease occur primarily in women?
SCAD, takotsubo cardiomyopathy, and coronary vasospasm
What is a common cause of symptoms in women with typical angina symptoms and nonobstructive coronary stenoses?
Microvascular dysfunction
What is a unique manifestation of cardiovascular disease that occurs primarily in women?
Takotsubo cardiomyopathy
What is the predominant symptom in women with acute MI, although they can also have atypical symptoms?
Chest pain or pressure
What is the recommended blood pressure goal for most patients with diabetes?
Less than 140/90 mm Hg
What is the impact of diabetes on the risk for CAD events?
Two to threefold increase in age adjusted risk
What is the recommendation for routine stress testing in asymptomatic persons with diabetes?
Not recommended
What is foundational for patients with diabetes and CAD?
Optimal medical therapy, including aggressive risk factor reduction, glucose control, and antianginal therapy
What is the American Diabetes Association's (ADA) recommended blood pressure target for patients at lower risk for ASCVD?
Less than 140/90 mm Hg
What is the preferred antihypertensive therapy for patients with diabetes, according to the American College of Cardiology/American Heart Association guidelines?
ACE inhibitors or ARBs
What is recommended for secondary prevention in all patients with diabetes and CAD?
High-intensity statin therapy
What does tight glycemic control reduce in patients with diabetes?
Risk of microvascular complications
What has been shown to reduce rates of acute MI, stroke, and cardiovascular death in patients with type 2 diabetes?
$SGLT2$ inhibitors or $GLP1$ receptor agonists
What is associated with improved outcomes, including lower rates of repeat revascularization and the composite of death, MI, or stroke?
Surgical revascularization
What has been shown to provide lasting benefit independent of revascularization modality?
Optimal medical therapy
What does the American Diabetes Association recommend introducing as part of a glycemic control regimen in patients with type 2 diabetes and clinical ASCVD?
SGLT2 inhibitor or GLP1 receptor agonist with demonstrated cardiovascular disease benefit
What is the recommended blood pressure goal for most patients with diabetes?
Less than 140/90 mm Hg
What is the primary purpose of routine stress testing in asymptomatic persons with diabetes?
It is controversial and without proven outcome benefit
What is foundational for patients with diabetes and CAD?
Optimal medical therapy, including aggressive risk factor reduction, glucose control, and antianginal therapy
What is the diagnostic accuracy of noninvasive stress testing in symptomatic patients with diabetes compared to patients without diabetes?
Similar
What is the recommended blood pressure target for patients with diabetes and existing ASCVD or a 10-year ASCVD risk of 15% or greater?
Less than 130/80 mm Hg
What is the preferred antihypertensive therapy for patients with diabetes?
ACE inhibitors or ARBs
What is indicated in patients with diabetes and CAD for optimal lipid control?
High intensity statin therapy with the addition of ezetimibe or PCSK9 inhibitors
What is recommended for secondary prevention in all patients with diabetes and CAD?
Aspirin
What has been shown to reduce microvascular complications but does not reduce the risk for MI, particularly when initiated late in the disease course?
\beta-blockers
What is the recommended approach for glycemic control in patients with type 2 diabetes mellitus and clinical atherosclerotic cardiovascular disease?
Initiation of sodium-glucose cotransporter 2 inhibitor or glucagon-like peptide I receptor agonist without demonstrated cardiovascular disease benefit
What is the association of coronary artery bypass grafting (CABG) in patients with diabetes mellitus undergoing revascularization?
Lower rates of repeat revascularization and adverse events compared to PCI
When is stress testing recommended for patients with diabetes mellitus?
Routine stress testing is not recommended in asymptomatic patients with diabetes mellitus
What is the recommended approach for glycemic control in patients with type 2 diabetes mellitus and clinical atherosclerotic cardiovascular disease?
Sodium-glucose cotransporter 2 inhibitor or glucagon-like peptide I receptor agonist with demonstrated cardiovascular disease benefit
What is stress testing routinely recommended for in asymptomatic patients with diabetes mellitus?
Detecting subclinical coronary artery disease
What is associated with improved outcomes in patients with diabetes mellitus undergoing revascularization?
Coronary artery bypass grafting
Test your knowledge of medical therapies for acute coronary syndromes with this quiz. Explore the use of aspirin, supplemental oxygen, nitrates, beta-blockers, ACE inhibitors, and high-intensity statin therapy in managing ACS.
Make Your Own Quizzes and Flashcards
Convert your notes into interactive study material.
Get started for free
