About acute coronary syndrome

MCQs cardiology
#1

About acute coronary syndrome

  1. Chest pain at rest…

ST elevation… cardiac enzymes normal = Prinzmetal angina

(treat with nitrates and calcium channel blockers) ; Remember HereBeta blocker contraindicated

  1. Chest pain with exertion,

relieved by nitroglycerin, Usually lasts a short time (5 minutes or less) = Stable angina

  1. Chest pain at rest…

ST elevaretion…cardiac enzymes elevated = STEMI

  1. Chest pain at rest…

No ST elevation…cardiac enzymes elevated = NSTEMI

  1. Chest pain at rest…

no ST elevation… no cardiac enzymes…Unstable angina

  1. Unstable, NSTEMI, STEMI : Aspirin, P2Y12 antagonists, Nitrates.(given in all 3), after stabilised ACEI, beta blocker.

  2. NSTEMI need 30 mg i/v enoxaprin or heparin to prevent restenosis

  3. For STEMI… Reperfusion / angioplasty

  4. For acute management of MI:

GIVE…

MONA (Morphine, oxygen, nitrates, aspirin)

  1. REMEMBER …

Do not give NITROGLYCERIN in Inferior wall MI with RV infarction and or hypotension ; but give i/v fluids if patient is hypotensive.

  1. REMEMBER

DOOR -to-first ECG time (goal <10 minutes)

  1. REMEMBER …

Door to needle time: within 30 minutes (i.e time for thrombolysis)

  1. REMEMBER

Door to balloon time:within 90 minutes (i.e time for PCI)

  1. REMEMBER …

Most common cause of death after MI is arrhythmias

  1. REMEMBER ALWAYS …

New murmur after MI with lung congestion = MR due to rupture or dysfunction of papillary muscle.

15.) REMEMBER ALWAYS …

New murmur after MI with step up oxygen saturation on right ventricle = ventricular septal rupture

16.) REMEMBER…

Pulseless electrical activity after MI with raised JVP and muffled heart sound =anterior wall rupture (cardiac temponade)