MKSAP19 Medical Therapy for Acute Coronary Syndromes-Heart Failure
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Questions and Answers

What is the recommended therapy for reducing infarct size in patients with ACS?

  • Thrombolytic therapy
  • High intensity statin therapy
  • Supplemental oxygen
  • B-blockers (correct)

    • When is thrombolytic therapy recommended for patients with NSTE ACS?

  • Recommended for elderly patients
  • Recommended for reducing infarct size
  • Not recommended (correct)
  • Always recommended

    • What should all patients presenting with ACS receive?

  • Thrombolytic therapy
  • Supplemental oxygen for any oxygen saturation level
  • A loading dose of aspirin (correct)
  • High intensity statin therapy

    • What therapy is not recommended for patients with NSTE ACS?

    <p>Thrombolytic therapy</p> Signup and view all the answers

    What should all patients presenting with ACS receive as a loading dose?

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

    What therapy is recommended to reduce infarct size in patients with ACS?

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

    What is the recommended daily dose of aspirin for patients with ACS after the initial administration?

    <p>81 to 162 mg</p> Signup and view all the answers

    In which patients is prasugrel indicated?

    <p>Patients treated with PCI</p> Signup and view all the answers

    When is clopidogrel or ticagrelor therapy recommended after ACS presentation?

    <p>For 1 year</p> Signup and view all the answers

    When are intravenous glycoprotein IIb/IIIa inhibitors generally reserved for use?

    <p>During PCI in patients with evident thrombus at the time of coronary angiography and intervention</p> Signup and view all the answers

    What is the recommended daily maintenance dose of aspirin for patients with ACS?

    <p>81 to 162 mg</p> Signup and view all the answers

    In which patients is prasugrel indicated?

    <p>Patients treated with PCI</p> Signup and view all the answers

    When is early clopidogrel loading recommended for patients with ACS?

    <p>Regardless of reperfusion or revascularization strategy</p> Signup and view all the answers

    When is intravenous glycoprotein IIb/IIIa inhibitors administration associated with lack of benefit and increased bleeding risk?

    <p>In patients tolerant of DAPT in the emergency department</p> Signup and view all the answers

    What anticoagulant is favored over enoxaparin for patients undergoing PCI, especially those with kidney dysfunction?

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

    What anticoagulant is associated with reduced reocclusion of the infarct related artery and improved outcomes in patients receiving thrombolytic therapy?

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

    For how long is anticoagulation recommended in medically treated patients presenting with ACS?

    <p>At least 48 hours and generally continued until discharge</p> Signup and view all the answers

    What is the preferred anticoagulant for patients undergoing PCI, especially those with kidney dysfunction?

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

    Which anticoagulant is associated with reduced reocclusion of the infarct related artery and improved outcomes in patients receiving thrombolytic therapy?

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

    When is fondaparinux not indicated during PCI for ACS?

    <p>Risk for procedural thrombosis</p> Signup and view all the answers

    What is the recommended oxygen saturation level for initiating oxygen therapy in ACS patients?

    <p>90% to 92%</p> Signup and view all the answers

    When should B-blockers be administered in ACS patients?

    <p>Orally within 24 hours of presentation</p> Signup and view all the answers

    What is the primary purpose of using nitrates in ACS?

    <p>Manage angina symptoms</p> Signup and view all the answers

    When is intravenous nitroglycerin recommended for ACS patients?

    <p>For patients with persistent chest pain despite B-blockade</p> Signup and view all the answers

    What is the recommended oxygen saturation level for initiating oxygen therapy in ACS patients?

    <p>Less than 90% to 92%</p> Signup and view all the answers

    When should B-blockers be administered in ACS patients?

    <p>Orally within 24 hours of presentation</p> Signup and view all the answers

    What is the primary purpose of using nitrates in ACS?

    <p>To manage angina symptoms and relieve chest pain</p> Signup and view all the answers

    When is intravenous nitroglycerin recommended for ACS patients?

    <p>For patients with persistent chest pain despite B-blockade</p> Signup and view all the answers

    What is the recommended therapy for reducing infarct size in patients with ACS?

    <p>Early statin therapy</p> Signup and view all the answers

    When should eplerenone, an aldosterone antagonist, be initiated in patients with STEMI?

    <p>Within 1 week of presentation</p> Signup and view all the answers

    What is the primary indication for using ARBs in patients with ACS?

    <p>Intolerance to ACE inhibitors</p> Signup and view all the answers

    What is the recommended timing for administering high-intensity statin therapy in ACS patients?

    <p>Initiating in the inpatient setting</p> Signup and view all the answers

    Which medication has been associated with lower rates of periprocedural MI when preloaded before PCI?

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

    In the absence of contraindications, when should ACE inhibitors be administered in patients with ACS?

    <p>Within 24 hours of presentation</p> Signup and view all the answers

    For which patients with ACS is eplerenone beneficial when initiated within 1 week of presentation?

    <p>Patients with ejection fraction of 40% or less and either heart failure or diabetes</p> Signup and view all the answers

    In which patients are ARBs indicated in the absence of ACE inhibitor tolerance?

    <p>Patients with diabetes</p> Signup and view all the answers

    What is the recommended duration for dual antiplatelet therapy after acute coronary syndrome (ACS)?

    <p>1 year</p> Signup and view all the answers

    In which patients is prasugrel indicated for use in ACS?

    <p>Patients treated with percutaneous coronary intervention</p> Signup and view all the answers

    When are B-Blockers contraindicated in patients with acute coronary syndrome?

    <p>In patients with high-grade atrioventricular block</p> Signup and view all the answers

    What is the recommended duration for dual antiplatelet therapy after acute coronary syndrome (ACS)?

    <p>1 year</p> Signup and view all the answers

    When should B-blockers be avoided in patients with acute coronary syndrome?

    <p>During cardiogenic shock</p> Signup and view all the answers

    Which medication may be used only in patients treated with percutaneous coronary intervention (PCI) for ACS?

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

    What is the common cause of chest pain among younger women who present with ACS and in the peripartum period?

    <p>Spontaneous coronary artery dissection (SCAD)</p> Signup and view all the answers

    What is the pathophysiology of SCAD?

    <p>Involves development of a nontraumatic and non iatrogenic intramural hematoma with or without intimal dissection with luminal communication</p> Signup and view all the answers

    How is diagnosis of SCAD confirmed?

    <p>By invasive or noninvasive angiography, using care to minimize unnecessary radiation exposure</p> Signup and view all the answers

    When associated with STEMI, how may SCAD be managed?

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

    Which condition involves MI in the absence of obstructive CAD?

    <p>Spontaneous coronary artery dissection (SCAD)</p> Signup and view all the answers

    What is the common cause of chest pain among younger women who present with ACS and in the peripartum period?

    <p>Spontaneous coronary artery dissection (SCAD)</p> Signup and view all the answers

    How is diagnosis of Spontaneous coronary artery dissection (SCAD) confirmed?

    <p>High index of suspicion and confirmation by invasive or noninvasive angiography</p> Signup and view all the answers

    When associated with STEMI, how may Spontaneous coronary artery dissection (SCAD) be managed?

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

    Which of the following is a common trigger for spontaneous coronary vasospasm?

    <p>Illicit substances</p> Signup and view all the answers

    How is coronary vasospasm typically diagnosed?

    <p>Coronary angiography</p> Signup and view all the answers

    What is the empirical treatment for patients suspected of having vasospasm or microvascular endothelial dysfunction?

    <p>Nitrates and/or calcium channel blockers</p> Signup and view all the answers

    What is the primary diagnostic method for excluding fixed disease in patients suspected of having coronary vasospasm?

    <p>Coronary angiography</p> Signup and view all the answers

    Which drugs are commonly associated with triggering spontaneous coronary vasospasm?

    <p>Methamphetamines and bromocriptine</p> Signup and view all the answers

    What is the empirical treatment often used for patients suspected of having vasospasm or microvascular endothelial dysfunction?

    <p>Nitrates and calcium channel blockers</p> Signup and view all the answers

    What is the recommended duration for dual antiplatelet therapy after an acute coronary syndrome (ACS)?

    <p>1 year</p> Signup and view all the answers

    When should implantable cardioverter defibrillator placement be avoided for primary prevention after myocardial infarction?

    <p>Within 40 days of infarction</p> Signup and view all the answers

    For which patients is nonstatin drug therapy considered beneficial in addition to maximally tolerated statin therapy?

    <p>Patients with a history of one major ASCVD event and multiple high risk conditions</p> Signup and view all the answers

    When is aspirin therapy recommended to be continued indefinitely for patients with ACS?

    <p>Preferably 81 mg/d</p> Signup and view all the answers

    What is the recommended duration for dual antiplatelet therapy (DAPT) after an acute coronary syndrome (ACS)?

    <p>At least 1 year</p> Signup and view all the answers

    In patients at risk for sudden cardiac death after MI, when is implantable cardioverter defibrillator (ICD) placement not recommended for primary prevention?

    <p>Within 40 days of infarction</p> Signup and view all the answers

    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?

    <p>Patients with a history of multiple major ASCVD events or one major ASCVD event and multiple high-risk conditions</p> Signup and view all the answers

    In patients with ACS, when are NSAIDs recommended to be avoided?

    <p>If possible, due to the increased cardiovascular risk associated with these drugs</p> Signup and view all the answers

    What is the primary benefit of referring patients with ACS for cardiac rehabilitation?

    <p>Improving functional capacity and reducing mortality</p> Signup and view all the answers

    What is a key outcome of medically observed exercise programs for patients with ACS?

    <p>Reduced mortality</p> Signup and view all the answers

    What is the purpose of cardiac rehabilitation for patients with ACS?

    <p>To improve overall health and reduce mortality</p> Signup and view all the answers

    What is a primary benefit of cardiac rehabilitation for patients with ACS?

    <p>Reduction in mortality</p> Signup and view all the answers

    What is a key outcome of medically observed exercise programs for patients with ACS?

    <p>Reduced mortality</p> Signup and view all the answers

    In addition to reducing mortality, what else does cardiac rehabilitation aim to improve for patients with ACS?

    <p>Risk factor profiles</p> Signup and view all the answers

    What is the current status of guideline recommendations for evaluating patients with silent myocardial ischemia?

    <p>Guideline recommendations for evaluating patients with silent myocardial ischemia do not exist</p> Signup and view all the answers

    What is the prognosis for patients with silent myocardial ischemia, especially those with known underlying heart disease?

    <p>They have a worse prognosis compared to those without underlying heart disease</p> Signup and view all the answers

    What has led to an increasing recognition of silent myocardial ischemia?

    <p>Diagnostic chest imaging and dedicated coronary artery calcium scoring studies</p> Signup and view all the answers

    What is the current status of guideline recommendations for evaluating patients with silent myocardial ischemia?

    <p>There are no guideline recommendations for evaluating patients with silent myocardial ischemia</p> Signup and view all the answers

    What is the primary diagnostic method for excluding fixed disease in patients suspected of having coronary vasospasm?

    <p>Coronary angiography</p> Signup and view all the answers

    What is the impact of silent myocardial ischemia on the prognosis of patients with known underlying heart disease?

    <p>It worsens the prognosis</p> Signup and view all the answers

    What is a contributing factor to the under-treatment of older adults with cardiovascular disease?

    <p>Perceived heightened risk for adverse therapeutic response</p> Signup and view all the answers

    Why are invasive angiography and revascularization used less often in older adults?

    <p>Higher procedural morbidity and mortality</p> Signup and view all the answers

    What remains an essential element of risk reduction in all age groups?

    <p>Exercise, diet, and healthy lifestyle choices</p> Signup and view all the answers

    What has been associated with adverse outcomes in the elderly according to recent meta-analysis?

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

    Why are older adults often not treated with recognized secondary prevention therapies for cardiovascular disease?

    <p>Due to a perceived heightened risk for adverse therapeutic response compounded by the lack of outcome data in these patients</p> Signup and view all the answers

    Why is exercise stress testing often limited or prohibited for prognostic and diagnostic purposes in older adults?

    <p>Comorbid conditions, loss of muscle mass, and gait abnormalities</p> Signup and view all the answers

    What remains essential for risk reduction in all age groups, regardless of age?

    <p>Exercise, diet, and healthy lifestyle choices</p> Signup and view all the answers

    What has a recent meta-analysis demonstrated about hyperlipidemia in the elderly?

    <p>Reduction in cardiac events and disability</p> Signup and view all the answers

    What is a predominant cause of symptoms in women with typical angina symptoms and nonobstructive coronary stenoses?

    <p>Microvascular dysfunction</p> Signup and view all the answers

    What is the predominant symptom in women with acute MI, although they can also have atypical symptoms?

    <p>Chest pain or pressure</p> Signup and view all the answers

    Which unique manifestations of cardiovascular disease occur primarily in women?

    <p>SCAD, takotsubo cardiomyopathy, and coronary vasospasm</p> Signup and view all the answers

    What is a common cause of symptoms in women with typical angina symptoms and nonobstructive coronary stenoses?

    <p>Microvascular dysfunction</p> Signup and view all the answers

    What is a unique manifestation of cardiovascular disease that occurs primarily in women?

    <p>Takotsubo cardiomyopathy</p> Signup and view all the answers

    What is the predominant symptom in women with acute MI, although they can also have atypical symptoms?

    <p>Chest pain or pressure</p> Signup and view all the answers

    What is the recommended blood pressure goal for most patients with diabetes?

    <p>Less than 140/90 mm Hg</p> Signup and view all the answers

    What is the impact of diabetes on the risk for CAD events?

    <p>Two to threefold increase in age adjusted risk</p> Signup and view all the answers

    What is the recommendation for routine stress testing in asymptomatic persons with diabetes?

    <p>Not recommended</p> Signup and view all the answers

    What is foundational for patients with diabetes and CAD?

    <p>Optimal medical therapy, including aggressive risk factor reduction, glucose control, and antianginal therapy</p> Signup and view all the answers

    What is the American Diabetes Association's (ADA) recommended blood pressure target for patients at lower risk for ASCVD?

    <p>Less than 140/90 mm Hg</p> Signup and view all the answers

    What is the preferred antihypertensive therapy for patients with diabetes, according to the American College of Cardiology/American Heart Association guidelines?

    <p>ACE inhibitors or ARBs</p> Signup and view all the answers

    What is recommended for secondary prevention in all patients with diabetes and CAD?

    <p>High-intensity statin therapy</p> Signup and view all the answers

    What does tight glycemic control reduce in patients with diabetes?

    <p>Risk of microvascular complications</p> Signup and view all the answers

    What has been shown to reduce rates of acute MI, stroke, and cardiovascular death in patients with type 2 diabetes?

    <p>$SGLT2$ inhibitors or $GLP1$ receptor agonists</p> Signup and view all the answers

    What is associated with improved outcomes, including lower rates of repeat revascularization and the composite of death, MI, or stroke?

    <p>Surgical revascularization</p> Signup and view all the answers

    What has been shown to provide lasting benefit independent of revascularization modality?

    <p>Optimal medical therapy</p> Signup and view all the answers

    What does the American Diabetes Association recommend introducing as part of a glycemic control regimen in patients with type 2 diabetes and clinical ASCVD?

    <p>SGLT2 inhibitor or GLP1 receptor agonist with demonstrated cardiovascular disease benefit</p> Signup and view all the answers

    What is the recommended blood pressure goal for most patients with diabetes?

    <p>Less than 140/90 mm Hg</p> Signup and view all the answers

    What is the primary purpose of routine stress testing in asymptomatic persons with diabetes?

    <p>It is controversial and without proven outcome benefit</p> Signup and view all the answers

    What is foundational for patients with diabetes and CAD?

    <p>Optimal medical therapy, including aggressive risk factor reduction, glucose control, and antianginal therapy</p> Signup and view all the answers

    What is the diagnostic accuracy of noninvasive stress testing in symptomatic patients with diabetes compared to patients without diabetes?

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

    What is the recommended blood pressure target for patients with diabetes and existing ASCVD or a 10-year ASCVD risk of 15% or greater?

    <p>Less than 130/80 mm Hg</p> Signup and view all the answers

    What is the preferred antihypertensive therapy for patients with diabetes?

    <p>ACE inhibitors or ARBs</p> Signup and view all the answers

    What is indicated in patients with diabetes and CAD for optimal lipid control?

    <p>High intensity statin therapy with the addition of ezetimibe or PCSK9 inhibitors</p> Signup and view all the answers

    What is recommended for secondary prevention in all patients with diabetes and CAD?

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

    What has been shown to reduce microvascular complications but does not reduce the risk for MI, particularly when initiated late in the disease course?

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

    What is the recommended approach for glycemic control in patients with type 2 diabetes mellitus and clinical atherosclerotic cardiovascular disease?

    <p>Initiation of sodium-glucose cotransporter 2 inhibitor or glucagon-like peptide I receptor agonist without demonstrated cardiovascular disease benefit</p> Signup and view all the answers

    What is the association of coronary artery bypass grafting (CABG) in patients with diabetes mellitus undergoing revascularization?

    <p>Lower rates of repeat revascularization and adverse events compared to PCI</p> Signup and view all the answers

    When is stress testing recommended for patients with diabetes mellitus?

    <p>Routine stress testing is not recommended in asymptomatic patients with diabetes mellitus</p> Signup and view all the answers

    What is the recommended approach for glycemic control in patients with type 2 diabetes mellitus and clinical atherosclerotic cardiovascular disease?

    <p>Sodium-glucose cotransporter 2 inhibitor or glucagon-like peptide I receptor agonist with demonstrated cardiovascular disease benefit</p> Signup and view all the answers

    What is stress testing routinely recommended for in asymptomatic patients with diabetes mellitus?

    <p>Detecting subclinical coronary artery disease</p> Signup and view all the answers

    What is associated with improved outcomes in patients with diabetes mellitus undergoing revascularization?

    <p>Coronary artery bypass grafting</p> Signup and view all the answers

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