Acute Coronary Syndromes Flashcards
7 cards from real Internal Medicine Exam practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 7 Acute Coronary Syndromes flashcards as text
A 70-year-old man with anterior STEMI develops cardiogenic shock. His BP is 75/50 mmHg and he is on maximum vasopressors. What is the most appropriate next step?
Answer: Insert an intra-aortic balloon pump (IABP) and proceed to PCI
Cardiogenic shock complicating STEMI requires mechanical circulatory support (IABP or more advanced devices) along with emergent PCI, which is the definitive treatment to restore perfusion.
Which troponin characteristic best distinguishes Type 2 MI (supply-demand mismatch) from Type 1 MI (plaque rupture)?
Answer: Clinical context and absence of obstructive coronary disease on angiography in Type 2 MI
Type 2 MI is distinguished by clinical context (e.g., sepsis, tachyarrhythmia, anemia) causing supply-demand mismatch, often without obstructive CAD on angiography, rather than by troponin kinetics.
A post-STEMI patient is started on an ACE inhibitor. What is the PRIMARY evidence-based indication for this therapy?
Answer: Reduction of LV remodeling and mortality, especially with reduced EF
ACE inhibitors reduce LV remodeling, HF, and mortality after MI, with greatest benefit in patients with anterior STEMI or reduced ejection fraction (EF ≤40%).
Spontaneous coronary artery dissection (SCAD) causing ACS most commonly occurs in which patient population?
Answer: Young women in the peripartum period or with fibromuscular dysplasia
SCAD predominantly affects young women, especially peripartum or those with fibromuscular dysplasia, and presents with ACS without typical atherosclerotic risk factors.
A patient with STEMI undergoes primary PCI. Post-procedure, the culprit vessel is patent but the patient has no ST resolution and persistent symptoms. What phenomenon best explains this?
Answer: No-reflow phenomenon
No-reflow occurs when myocardial perfusion is inadequate despite a patent epicardial artery, caused by microvascular obstruction from embolization of debris and reperfusion injury.
Which statin regimen is recommended for all ACS patients regardless of baseline LDL level?
Answer: High-intensity statin (e.g., atorvastatin 40-80 mg or rosuvastatin 20-40 mg)
Guidelines recommend high-intensity statin therapy for all ACS patients to achieve LDL <70 mg/dL and reduce cardiovascular events, regardless of baseline LDL.
In a STEMI patient presenting 3 hours after symptom onset at a non-PCI-capable hospital, what is the recommended door-to-device (DTD) time if transfer for primary PCI is chosen?
Answer: Within 120 minutes
If primary PCI is chosen at a non-PCI-capable hospital, the total first-medical-contact-to-device time should be ≤120 minutes; otherwise, fibrinolysis should be administered first.