Acute Coronary Syndrome Flashcard 5

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Rationale

B. Rationale: There is insufficient evidence to support the routine use of oxygen in uncomplicated ACS without signs of hypoxemia or heart failure, or both.

Question

Oxygen:

a. Should be given at an FiO₂ of 100%
b. Should be titrated to an oxygen saturation ≥ 94%
c. Should be routinely used in ACS
d. All of the above

Answer

b. Should be titrated to an oxygen saturation ≥ 94%

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Rationale

A. Rationale: PCI is preferred in patients who present with STEMI within 3 hours or less of symptom onset, as treatment is more time-sensitive. If the receiving hospital does not have PCI capabilities and it is within 90 minutes of the onset of STEMI, transfer to a facility with PCI capabilities should be considered.

Question

PCI:

a. Is preferred in patients with contraindications to fibrinolytics
b. Is indicated in patients with STEMI who present ≥ 3 hours from the onset of symptoms
c. Should not be considered if the hospital does not have PCI capabilities
d. Should not be used in preference to fibrinolytics

Answer

a. Is preferred in patients with contraindications to fibrinolytics

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Rationale

D. Rationale: Reperfusion therapy includes both drugs and catheterization and may cause an arrhythmia as the occluded artery opens.

Question

Reperfusion therapy:

a. May cause arrhythmias
b. Opens an occluded coronary artery with drugs
c. Opens an occluded coronary artery with catheterization
d. All of the above

Answer

d. All of the above

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Rationale

D. Rationale: IV nitroglycerin should be titrated to relieve ischemic chest pain. Routine use has not been shown to reduce mortality in the case of STEMI. It is recommended for the relief of hypertension and pulmonary edema complicating STEMI.

Question

Routine use of IV nitroglycerin:

a. Has been shown to significantly reduce mortality in the case of STEMI
b. Is not recommended with pulmonary edema
c. Is not recommended for hypertension complicating STEMI
d. Should be titrated for relief of ischemic chest discomfort

Answer

d. Should be titrated for relief of ischemic chest discomfort

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Rationale

D. Rationale: If an ST elevation myocardial infarction is present in a recently resuscitated patient, urgent coronary angiography must be performed for possible stenting or recanalization of a diseased artery.

Question

ST elevation myocardial infarction (STEMI) is confirmed via ECG in a recently resuscitated patient. What is the next intervention?

a. An IV bolus of 1–2 L of normal saline or lactated Ringer solution
b. Repeat ECG after 6 hours
c. Close observation
d. Coronary angiography for possible stenting/recanalization

Answer

d. Coronary angiography for possible stenting/recanalization

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Rationale

A. Rationale: STEMI is characterized by ST segment elevation in 2 or more contiguous leads or new LBBB.

Question

STEMI is characterized by:

A. ST-segment elevation in 2 or more contiguous leads or new LBBB
B. Ischemic ST segment depression ≥ 0.5 mm or dynamic T wave inversion with pain or discomfort
C. Non diagnostic changes in the ST segment or T wave
D. Nonpersistent/transient ST elevation ≥ 0.5 mm for < 20 minutes

Answer

A. ST-segment elevation in 2 or more contiguous leads or new LBBB

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Rationale

A. Rationale: The classifications include abnormal with STEMI, abnormal with nonSTEMI, and normal or nondiagnositic.

Question

The classification of ECG in the ACS scenario includes which one of the following categories:

a. Abnormal with STEMI
b. Normal with non-STEMI
c. Trans-mural MI
d. Normal with ischemic changes

Answer

a. Abnormal with STEMI

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Rationale

A. Rationale: Hypotension, including hypotension from a right ventricular or right inferior infarction, is the major contraindication to the use of both morphine and nitroglycerin. In the presence of RV or right inferior infarction, administering these drugs may result in severe hypotension. Recent GI bleed or hemorrhagic stroke are contraindications to aspirin administration. Phosphodiesterase inhibitor is a contraindication to administration of nitroglycerin, but not to morphine use.

Question

The major contraindication to administering both nitroglycerin and morphine is:

A. Hypotension
B. Recent GI bleed
C. Recent CVA
D. Recent phosphodiesterase inhibitor use

Answer

A. Hypotension

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Rationale

B. Rationale: Although all of these are symptoms of ischemia and/or myocardial infarction, retrosternal chest pain is the most common symptom. Dizziness, diaphoresis, and/or nausea/vomiting may also occur. Chest pain may be described as squeezing, burning, or fullness in the center of the chest. Pain generally lasts for more than a few minutes.

Question

The most common symptom of ischemia and/or myocardial infarction is:

A. Arm, neck, or jaw pain
B. Chest pain behind the sternum (retrosternal chest pain)
C. Pain between the shoulder blades
D. Sudden shortness of breath not explained by other reasons