ACLS Acute Coronary Syndromes 2 — Questions and Answers
Question 1: A patient presents with chest pain and an ECG showing ST elevation in leads II, III, and aVF. Which coronary artery is most likely occluded?
- Left anterior descending artery
- Right coronary artery (Correct answer)
- Left circumflex artery
- Left main coronary artery
Correct answer: Right coronary artery
ST elevation in leads II, III, and aVF indicates an inferior STEMI, most commonly caused by occlusion of the right coronary artery.
Question 2: Which of the following is the preferred reperfusion strategy for STEMI if PCI can be performed within 90 minutes of first medical contact?
- Fibrinolytic therapy
- Coronary artery bypass grafting
- Primary percutaneous coronary intervention (Correct answer)
- Intravenous nitroglycerin infusion
Correct answer: Primary percutaneous coronary intervention
Primary PCI is the preferred reperfusion strategy for STEMI when it can be performed within 90 minutes of first medical contact at a PCI-capable center.
Question 3: A patient with NSTEMI has ongoing chest pain despite aspirin, heparin, and nitroglycerin. What is the next best step?
- Immediate fibrinolytic therapy
- Add a P2Y12 inhibitor such as ticagrelor or clopidogrel (Correct answer)
- Discontinue heparin and observe
- Administer atropine 0.5 mg IV
Correct answer: Add a P2Y12 inhibitor such as ticagrelor or clopidogrel
Dual antiplatelet therapy with aspirin plus a P2Y12 inhibitor (ticagrelor, clopidogrel, or prasugrel) is indicated for NSTEMI management.
Question 4: Which biomarker is most specific for myocardial injury and is the preferred marker for diagnosing ACS?
- Creatine kinase (CK-MB)
- Myoglobin
- Troponin I or Troponin T (Correct answer)
- Lactate dehydrogenase (LDH)
Correct answer: Troponin I or Troponin T
Cardiac troponin I and T are the most sensitive and specific biomarkers for myocardial injury and are the preferred markers for ACS diagnosis.
Question 5: A 58-year-old male presents with diaphoresis, nausea, and jaw pain but denies chest pain. His ECG shows new ST elevation. What is the most likely diagnosis?
- Panic attack
- STEMI with atypical presentation (Correct answer)
- Pericarditis
- Pulmonary embolism
Correct answer: STEMI with atypical presentation
STEMI can present atypically with jaw pain, nausea, and diaphoresis without classic chest pain, particularly in diabetic patients and women.
Question 6: What is the maximum single dose of aspirin recommended for initial ACS treatment in the prehospital or ED setting?
- 81 mg
- 162–325 mg (Correct answer)
- 500 mg
- 650 mg
Correct answer: 162–325 mg
The recommended initial aspirin dose for suspected ACS is 162–325 mg (non-enteric coated) chewed as soon as possible.
Question 7: Which of the following findings on ECG is most consistent with posterior STEMI?
- ST elevation in V1–V4
- ST depression with tall R wave in V1–V2 (Correct answer)
- New left bundle branch block
- Diffuse ST elevation with PR depression
Correct answer: ST depression with tall R wave in V1–V2
Posterior STEMI manifests as ST depression with tall, broad R waves in leads V1–V2, representing a mirror image of posterior wall injury.
ACLS Acute Coronary Syndromes 2
A patient presents with chest pain and an ECG showing ST elevation in leads II, III, and aVF.
Which coronary artery is most likely occluded?