Acute Coronary Syndrome (ACS) Practice Flashcards

A set of 40 vocabulary flashcards covering the pathophysiology, diagnosis, and management of Acute Coronary Syndrome based on lecture notes.

Atherosclerosis

The most common cause of Coronary Artery Disease (CAD).

Stable angina pain

Chest pain that occurs during exertion.

Stable angina relief

Symptoms are typically relieved by rest or the administration of nitroglycerin, usually <15 minutes

Stable angina troponins

Cardiac troponin levels remain normal in this condition.

Stable angina ECG

Usually presents as normal when the patient is at rest.

Unstable angina mechanism

Occurs due to plaque rupture without subsequent myocardial necrosis.

NSTEMI mechanism

Occurs due to partial coronary artery occlusion resulting in myocardial necrosis.

STEMI mechanism

Occurs due to complete coronary artery occlusion.

STEMI ECG

ST elevation in contiguous leads with reciprocal ST depression

NSTEMI ECG

May show ST depression, T-wave inversion, or appear normal.

Troponin (Diagnostic Use)

The biomarker used to distinguish between Unstable Angina (UA) and NSTEMI.

Troponin

The most sensitive cardiac biomarkers.

Aspirin

The first medication to be administered in Acute Coronary Syndrome (ACS).

PCI (Percutaneous Coronary Intervention)

The preferred treatment for STEMI.

Door-to-balloon goal (PCI)

A target time of $\le 90\,\text{minutes}$.

Fibrinolytics (Indication)

Indicated for STEMI when PCI is unavailable.

Fibrinolytics (NSTEMI)

These medications are never indicated for NSTEMI.

High-intensity statin

Initated after an Acute Coronary Syndrome (ACS) event.

Beta blocker

The first-line chronic antianginal medication.

Nitroglycerin

The best PRN (pro re nata) antianginal medication.

Prinzmetal angina cause

Prompted by coronary vasospasm.

Prinzmetal treatment

Calcium channel blockers

Prinzmetal ECG

Characterized by transient ST elevation.

Inferior MI leads

II, III, and aVF.

Anterior MI leads

V1–V4.

Lateral MI leads

I, aVL, V5–V6.

Right coronary artery (RCA)

Supplies the inferior wall of the heart.

Left Anterior Descending (LAD)

Supplies the anterior wall of the heart.

Arrhythmia

The most common early complication following a Myocardial Infarction (MI).

Papillary muscle rupture

A complication that causes acute Mitral Regurgitation (MR).

VSD (Ventricular Septal Defect) timing

Typically occurs $3-5\,\text{days}$ post-MI.

Free wall rupture

A complication that leads to cardiac tamponade.

Dressler syndrome timing

A complication that occurs weeks after an MI.

Oxygen in ACS

Administered only if the patient is hypoxemic.

Nitroglycerin contraindication

Recent use of PDE-5 inhibitors (ie sildafenil)

ACS pain duration

Typically lasts $> 20\,\text{minutes}$.

Atypical ACS presentation

Women, elderly, diabetics: often present with dyspnea, fatigue, nausea, epigastric pain

Coronary angiography

The gold standard for diagnosing Coronary Artery Disease (CAD).

ACE inhibitor

A drug used to reduce cardiac remodeling post-MI.

how long does troponin remain elevated post MI

7-14 days

dressler syndrome

post cardiac injury pericarditis with full inflammatory reaction (ie fever, etc)

Left circumflex artery (LCX)

Supplies the lateral wall of the heart.

How does aspirin reduce mortality in MI

irreversible inhibition of COX-1

high intensity statins

atorvastatin 40-80mg, rosuvastatin 20-40mg

dual antiplatelet therapy (DAPT)

aspirin + P2Y12 inhibitor (for chronic use, prevents platelets from sticking together)

role of heparin in STEMI

anticoagulant, prevent clotting, short term fast acting, use with DAPT

cardiac stress test

may diagnose stable angina

when do you add an ACE inhibitor (to BB) for stable angina treatment

patients with concurrent DM, HTN, CKD, reduced EF

unstable angina vs NSTEMI presentation

cannot distinguish, treat as NSTEMI until troponin returns

NSTEMI treatment algorithm

AB SNAP: aspirin, bb, statin, nitro, anticoagulation, P2Y12 inhibitor

example of a P2Y12 inhibitor

clopidogrel (aka plavix)

STEMI treatment algorithm

SHNAP: statin, heparin, nitro, aspirin, P2Y12 inhibitor

morphine use in MI

only for refractory pain

risk factors for prinzmetal angina

cocaine, smoking, migraines, raynauds

prinzmetal angina typical timing

late night/ early morning

what medication to avoid in prinzmetal angina

beta blockers