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 68-year-old man on warfarin (INR 2.4) for atrial fibrillation presents with NSTEMI. He undergoes PCI with a drug-eluting stent. What is the optimal antithrombotic regimen post-procedure?
Answer: Short course of triple therapy, then DOAC + P2Y12 inhibitor (dual therapy) for 12 months
Current guidelines recommend minimizing triple therapy duration (≤1 month) and transitioning to dual therapy with a DOAC plus P2Y12 inhibitor to reduce bleeding while maintaining thrombotic protection.
Which of the following is a contraindication to fibrinolytic therapy in STEMI?
Answer: Ischemic stroke within the past 3 months
Ischemic stroke within 3 months is an absolute contraindication to fibrinolysis due to risk of hemorrhagic transformation; prior CABG and advanced age are relative considerations but not absolute contraindications.
The GRACE risk score is used in ACS to predict which outcome?
Answer: In-hospital and 6-month mortality to guide invasive vs. conservative strategy
The GRACE score stratifies ACS mortality risk (low/intermediate/high) using variables like age, heart rate, BP, creatinine, cardiac arrest, ST deviation, troponin, and Killip class to guide invasive strategy timing.
A patient with inferior STEMI is brought to the cath lab. Coronary angiography reveals 100% occlusion of a large dominant RCA. After successful PCI to the RCA, which hemodynamic complication is most likely to respond to IV fluids?
Answer: Right ventricular failure from RV infarction
RV infarction causes preload-dependent hemodynamics; aggressive IV fluid resuscitation is the mainstay of treatment, as the failing RV needs adequate filling pressure to maintain forward output.
Which duration of dual antiplatelet therapy (DAPT) is generally recommended after drug-eluting stent (DES) placement for ACS?
Answer: At least 12 months
Current ACC/AHA guidelines recommend at least 12 months of DAPT after DES placement in ACS patients to reduce stent thrombosis and recurrent ischemic events.
A 72-year-old woman with STEMI who received successful primary PCI develops new sustained ventricular tachycardia (VT) on day 4 of hospitalization. What is the most likely underlying mechanism?
Answer: Re-entry through scar tissue at the infarct border zone
Late VT after MI (days 3-5+) is typically caused by re-entrant circuits formed at the border between infarcted and viable myocardium, distinct from early reperfusion arrhythmias.
A post-ACS patient is intolerant of ACE inhibitors due to cough. Which agent provides equivalent mortality benefit in patients with reduced ejection fraction?
Answer: Angiotensin receptor blocker (ARB) such as valsartan
ARBs (e.g., valsartan, losartan) provide equivalent cardiovascular mortality reduction post-MI with reduced EF and are the recommended alternative when ACE inhibitors are not tolerated due to cough.