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Questions and Answers
What does the 12-lead electrocardiogram (ECG) do for patients suspected of ACS?
What does the 12-lead electrocardiogram (ECG) do for patients suspected of ACS?
- Identifies the race of the patient
- Measures the Troponin levels directly
- Differentiates between ST-segment elevation and non-ST-segment elevation cases (correct)
- Predicts the exact number of affected coronary arteries
Which group is more prone to MI according to the text?
Which group is more prone to MI according to the text?
- Black men over 60
- White men of any age
- Black women of any age (correct)
- White women over 50
What has contributed to the decline in the incidence of STEMI according to the text?
What has contributed to the decline in the incidence of STEMI according to the text?
- Increased prevalence of 'silent' MIs
- Improved diagnostic accuracy of ECG
- Introduction of more sensitive assays for myocardial injury (correct)
- Decrease in age-related risk factors
What happens to the rate of MI with increasing age?
What happens to the rate of MI with increasing age?
In which region is STEMI noted to be on the rise according to the text?
In which region is STEMI noted to be on the rise according to the text?
What factor can lead to an increase in NSTEMI cases relative to STEMI?
What factor can lead to an increase in NSTEMI cases relative to STEMI?
Which racial group experiences MI more frequently in the United States according to the text?
Which racial group experiences MI more frequently in the United States according to the text?
What is not included in the estimate of ACS events according to the text?
What is not included in the estimate of ACS events according to the text?
(True/False) The rate of MI decreases with increasing age for both sexes according to the text.
(True/False) The rate of MI decreases with increasing age for both sexes according to the text.
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Study Notes
QRS Changes in STEMI
- The most characteristic change in QRS in STEMI patients is the evolution of Q waves in leads that interrogate the infarct zone.
Diagnosis of STEMI
- Patients with persistent ST-segment elevation are candidates for reperfusion therapy to restore flow in the occluded epicardial infarct-related artery.
- The 12-lead ECG is crucial in the initial decision pathway for managing patients with suspected ACS.
Pathologic Findings
- Gross alterations in the myocardium appear 6 to 12 hours after the onset of necrosis.
- Histochemical stains can identify zones of necrosis after only 2 to 3 hours.
Stress Cardiomyopathy
- Proposed diagnostic criteria include transient regional wall motion abnormalities, frequent preceding stressful trigger, absence of culprit CAD lesion, abnormal electrocardiographic and biomarker findings, and recovery of ventricular function over time.
- A clinical score (InterTAK Diagnostic Score) can provide good specificity for stress myopathy or ACS.
Epidemiology of STEMI
- STEMI remains a major public health problem in the industrialized world and is on the rise in developing countries.
- In the United States, over 1 million patients are hospitalized for an MI or coronary heart death each year.
- The rate of MI rises sharply with increasing age, with racial differences in incidence.
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