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Questions and Answers
Which of the following is a characteristic of Acute Coronary Syndromes (ACS)?
Which of the following is a characteristic of Acute Coronary Syndromes (ACS)?
- ACS leads to irreversible necrosis of heart muscle
- ACS can range from unstable angina to acute myocardial infarctions (correct)
- ACS is a non-life-threatening condition
- ACS only affects patients with coronary artery disease
What is the mortality rate for those experiencing a myocardial infarction (MI)?
What is the mortality rate for those experiencing a myocardial infarction (MI)?
- The mortality rate for MI has been steadily increasing in recent decades
- 1.3 million Americans die from MI each year
- 19% of men and 26% of women die from MI (correct)
- 14% of those experiencing a MI will die from it
What is the one-year morbidity rate after the initial MI is diagnosed?
What is the one-year morbidity rate after the initial MI is diagnosed?
- 1.3 million Americans are hospitalized each year due to MI
- The morbidity rate for MI has been steadily declining in recent decades
- 19% for men and 26% for women (correct)
- ACS only affects patients with coronary artery disease
Which of the following is true about troponin?
Which of the following is true about troponin?
When do troponin and CK-MB levels become elevated in the serum?
When do troponin and CK-MB levels become elevated in the serum?
What is the diagnostic utility of troponin and CK-MB levels in the early evaluation for an acute MI?
What is the diagnostic utility of troponin and CK-MB levels in the early evaluation for an acute MI?
Which of the following is a clinical marker of acute myocardial infarction?
Which of the following is a clinical marker of acute myocardial infarction?
What is the term used to describe the period of tissue resorption in the healing process of an infarcted myocardium?
What is the term used to describe the period of tissue resorption in the healing process of an infarcted myocardium?
Which of the following functional alterations is observed in acute coronary syndrome (ACS)?
Which of the following functional alterations is observed in acute coronary syndrome (ACS)?
What is the term used to describe the process where brief ischemic insults render myocardial tissue more resistant to subsequent episodes?
What is the term used to describe the process where brief ischemic insults render myocardial tissue more resistant to subsequent episodes?
Which of the following substances released during ischemia are believed to be key triggers of multiple signaling pathways?
Which of the following substances released during ischemia are believed to be key triggers of multiple signaling pathways?
Which of the following is a consequence of infarct expansion after a myocardial infarction?
Which of the following is a consequence of infarct expansion after a myocardial infarction?
Which of the following is true about ventricular remodeling after a myocardial infarction?
Which of the following is true about ventricular remodeling after a myocardial infarction?
Which of the following interventions can beneficially modify adverse ventricular remodeling?
Which of the following interventions can beneficially modify adverse ventricular remodeling?
Which factor can contribute to thrombus formation in atherosclerosis?
Which factor can contribute to thrombus formation in atherosclerosis?
What is the description of Type 2 MI?
What is the description of Type 2 MI?
Which layer of the myocardium is particularly susceptible to ischemia?
Which layer of the myocardium is particularly susceptible to ischemia?
Which factor determines the amount of tissue that succumbs to infarction?
Which factor determines the amount of tissue that succumbs to infarction?
Which symptom is commonly associated with an acute myocardial infarction in women?
Which symptom is commonly associated with an acute myocardial infarction in women?
What physical finding is indicative of volume overload in the presence of failing left ventricular systolic function?
What physical finding is indicative of volume overload in the presence of failing left ventricular systolic function?
What is the temporal sequence of EKG abnormalities in a ST-elevation myocardial infarction (STEMI)?
What is the temporal sequence of EKG abnormalities in a ST-elevation myocardial infarction (STEMI)?
What is the diagnostic criteria for unstable angina (UA)?
What is the diagnostic criteria for unstable angina (UA)?
Which of the following substances involved in normal hemostasis is produced by endothelial cells?
Which of the following substances involved in normal hemostasis is produced by endothelial cells?
What is the primary role of thrombomodulin in the coagulation process?
What is the primary role of thrombomodulin in the coagulation process?
Which of the following substances is responsible for degrading fibrin clots?
Which of the following substances is responsible for degrading fibrin clots?
Which of the following substances indirectly inhibits coagulation by augmenting blood flow and reducing shear stress?
Which of the following substances indirectly inhibits coagulation by augmenting blood flow and reducing shear stress?
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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
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