ACLS Acute Coronary Syndromes 4 — Questions and Answers
Question 1: A 65-year-old woman with diabetes presents with fatigue and dyspnea for 2 days. ECG shows ST depression in V4–V6 and troponin is elevated. What is the diagnosis?
- Unstable angina
- NSTEMI (Correct answer)
- STEMI
- Pericarditis
Correct answer: NSTEMI
Elevated troponin with ischemic symptoms (even atypical) and ST depression confirms NSTEMI — troponin elevation distinguishes it from unstable angina.
Question 2: The TIMI risk score for NSTEMI/UA is used to guide treatment intensity. Which of the following is NOT a component of the TIMI risk score?
- Age ≥ 65 years
- Known coronary artery disease
- Female sex (Correct answer)
- ST deviation on ECG
Correct answer: Female sex
Female sex is not a component of the TIMI risk score; the score includes age, CAD risk factors, known CAD, ST changes, elevated markers, and recent aspirin use.
Question 3: Which anticoagulant is preferred in NSTEMI patients managed with an early invasive strategy (planned PCI within 24 hours)?
- Subcutaneous fondaparinux
- Unfractionated heparin or bivalirudin (Correct answer)
- Warfarin loading dose
- Subcutaneous enoxaparin only
Correct answer: Unfractionated heparin or bivalirudin
Unfractionated heparin (UFH) or bivalirudin is preferred for patients undergoing PCI due to reversibility and established cath lab protocols.
Question 4: Nitroglycerin is contraindicated in which of the following ACS scenarios?
- Anterior STEMI with hypertension
- Inferior STEMI with right ventricular infarction (Correct answer)
- NSTEMI with ongoing chest pain
- STEMI with mild pulmonary edema
Correct answer: Inferior STEMI with right ventricular infarction
Nitroglycerin is contraindicated in right ventricular infarction because preload reduction can precipitate severe hypotension in RV-dependent patients.
Question 5: A patient presents with ACS and is found to have a history of prior intracranial hemorrhage. Which antiplatelet agent should be AVOIDED?
- Aspirin 81 mg
- Clopidogrel
- Prasugrel (Correct answer)
- Ticagrelor
Correct answer: Prasugrel
Prasugrel is contraindicated in patients with a history of stroke or TIA due to significantly increased risk of intracranial hemorrhage.
Question 6: What is the ACLS-recommended initial oxygen saturation target for ACS patients who are NOT hypoxic?
- Maintain SpO2 ≥ 94% with supplemental O2 routinely
- Do not administer supplemental oxygen; target SpO2 ≥ 94% only if hypoxic (Correct answer)
- Administer 100% O2 via non-rebreather mask for all ACS
- Maintain SpO2 between 88–92% to avoid hyperoxia
Correct answer: Do not administer supplemental oxygen; target SpO2 ≥ 94% only if hypoxic
Routine supplemental oxygen is not recommended for ACS patients with SpO2 ≥ 94%; oxygen should be given only to hypoxic patients to avoid potential harm.
Question 7: A patient with STEMI receives primary PCI. Which medication should be continued for at least 12 months post-stenting to reduce stent thrombosis risk?
- Warfarin
- A P2Y12 inhibitor (ticagrelor, prasugrel, or clopidogrel) (Correct answer)
- Low molecular weight heparin
- Dipyridamole
Correct answer: A P2Y12 inhibitor (ticagrelor, prasugrel, or clopidogrel)
Dual antiplatelet therapy (aspirin + P2Y12 inhibitor) for at least 12 months post-PCI is recommended to prevent stent thrombosis.
ACLS Acute Coronary Syndromes 4
A 65-year-old woman with diabetes presents with fatigue and dyspnea for 2 days.
ECG shows ST depression in V4–V6 and troponin is elevated.
What is the diagnosis?