26 Questions
Which of the following is a characteristic of Acute Coronary Syndromes (ACS)?
ACS can range from unstable angina to acute myocardial infarctions
What is the mortality rate for those experiencing a myocardial infarction (MI)?
19% of men and 26% of women die from MI
What is the one-year morbidity rate after the initial MI is diagnosed?
19% for men and 26% for women
Which of the following is true about troponin?
It is a regulatory protein in muscle cells
When do troponin and CK-MB levels become elevated in the serum?
A few hours after the onset of MI symptoms
What is the diagnostic utility of troponin and CK-MB levels in the early evaluation for an acute MI?
They are not useful in the early evaluation for an acute MI
Which of the following is a clinical marker of acute myocardial infarction?
All of the above
What is the term used to describe the period of tissue resorption in the healing process of an infarcted myocardium?
Yellow softening
Which of the following functional alterations is observed in acute coronary syndrome (ACS)?
All of the above
What is the term used to describe the process where brief ischemic insults render myocardial tissue more resistant to subsequent episodes?
Ischemic preconditioning
Which of the following substances released during ischemia are believed to be key triggers of multiple signaling pathways?
Adenosine and bradykinin
Which of the following is a consequence of infarct expansion after a myocardial infarction?
Decreased density of myocytes in the infarcted region
Which of the following is true about ventricular remodeling after a myocardial infarction?
It can lead to heart failure
Which of the following interventions can beneficially modify adverse ventricular remodeling?
Reperfusion therapies and drugs that interfere with the renin-angiotensin-aldosterone system
Which factor can contribute to thrombus formation in atherosclerosis?
Plaque rupture or erosion
What is the description of Type 2 MI?
Infarction resulting from an oxygen supply-demand mismatch that is not the result of plaque disruption and thrombosis
Which layer of the myocardium is particularly susceptible to ischemia?
Subendocardium
Which factor determines the amount of tissue that succumbs to infarction?
The adequacy of collateral vessels that provide blood flow from neighboring non-occluded coronary arteries
Which symptom is commonly associated with an acute myocardial infarction in women?
Chest pain or discomfort
What physical finding is indicative of volume overload in the presence of failing left ventricular systolic function?
S3 heart sound
What is the temporal sequence of EKG abnormalities in a ST-elevation myocardial infarction (STEMI)?
Initial ST-segment elevation, followed by inversion of the T wave and the appearance of pathologic Q waves
What is the diagnostic criteria for unstable angina (UA)?
The patient's symptoms, transient ST abnormalities on the ECG, absence of serum biomarkers of myocardial necrosis
Which of the following substances involved in normal hemostasis is produced by endothelial cells?
Tissue plasminogen activator
What is the primary role of thrombomodulin in the coagulation process?
Inhibiting the extrinsic coagulation pathway
Which of the following substances is responsible for degrading fibrin clots?
Tissue plasminogen activator
Which of the following substances indirectly inhibits coagulation by augmenting blood flow and reducing shear stress?
Prostacyclin
Study Notes
Characteristics of Acute Coronary Syndromes (ACS)
- High mortality rate, with up to 30% of patients experiencing a myocardial infarction (MI) dying within the first year
- High one-year morbidity rate after initial MI diagnosis, with up to 20% of patients experiencing a second event
Biomarkers of Acute Myocardial Infarction
- Troponin: a clinical marker of acute myocardial infarction
- Troponin and CK-MB levels become elevated in serum 2-4 hours after MI, peaking at 12-24 hours
- Diagnostic utility of troponin and CK-MB levels is high in early evaluation for acute MI
Pathophysiology of Acute Coronary Syndrome
- Functional alteration observed: decreased left ventricular function
- Ischemic preconditioning: brief ischemic insults render myocardial tissue more resistant to subsequent episodes
- Adenosine, bradykinin, and opioids are key triggers of multiple signaling pathways during ischemia
Consequences of Myocardial Infarction
- Infarct expansion: a consequence of MI, leading to ventricular remodeling
- Ventricular remodeling can be beneficially modified by certain interventions
- Thrombus formation is contributed to by factor VIII
Clinical Presentation of Acute Myocardial Infarction
- Type 2 MI: myocardial infarction secondary to imbalance between myocardial oxygen demand and supply
- Subendocardial layer of the myocardium is particularly susceptible to ischemia
- Area at risk determines the amount of tissue that succumbs to infarction
- Common symptom in women: fatigue
- Physical finding indicative of volume overload in failing left ventricular systolic function: jugular venous distension
- Temporal sequence of EKG abnormalities in STEMI: hyperacute T-waves, ST-segment elevation, Q-waves, and inverted T-waves
- Diagnostic criteria for unstable angina (UA): anginal symptoms at rest, new-onset angina, or increasing frequency/severity
Hemostasis and Coagulation
- Endothelial cells produce thrombomodulin, which activates protein C to inhibit coagulation
- Thrombomodulin's primary role is to activate protein C to degrade fibrin clots
- Nitric oxide indirectly inhibits coagulation by augmenting blood flow and reducing shear stress
Test your knowledge on atypical symptoms of a heart attack in different patient groups. Discover how chest pain may not be the only indicator and learn about the signs that may be more common in women, diabetics, and the elderly. Challenge your understanding of heart attack symptoms and improve your awareness of these important health concerns.
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