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 55-year-old man with prior PCI (bare-metal stent placed 1 month ago) requires urgent non-cardiac surgery. What is the recommended approach to his dual antiplatelet therapy (DAPT)?
Answer: Continue both antiplatelet agents perioperatively
For bare-metal stents within 4 weeks of placement, elective surgery should be deferred; if surgery is truly urgent, continuing DAPT perioperatively is preferred to prevent stent thrombosis.
Which biomarker has the fastest rise-and-fall kinetics and was historically used for early diagnosis of re-infarction after STEMI?
Answer: CK-MB (creatine kinase-MB)
CK-MB rises and falls more rapidly than troponin (peaks at 24h, normalizes by 48-72h), making it useful for detecting re-infarction when troponin remains elevated from the initial event.
Wellens' syndrome (Type A and B T-wave patterns in V2-V3) in a patient with resolved chest pain indicates which critical finding?
Answer: Critical proximal LAD stenosis with intermittent reperfusion
Wellens' syndrome represents reperfusion T-wave changes from a critical proximal LAD lesion; stress testing is contraindicated as it can precipitate massive anterior STEMI.
A patient with ACS is found to have a platelet count of 48,000/μL after receiving heparin for 7 days. The most likely diagnosis is:
Answer: Heparin-induced thrombocytopenia (HIT)
HIT is characterized by a >50% platelet drop 5-10 days after heparin initiation, associated with a prothrombotic state rather than bleeding, and requires immediate heparin cessation and alternative anticoagulation.
Which finding on echocardiogram performed after STEMI is associated with the highest risk of systemic embolization?
Answer: Apical left ventricular thrombus
LV thrombus, most common after large anterior STEMI with apical akinesis, carries significant risk of systemic embolization and stroke, requiring anticoagulation therapy.
Cocaine-induced ACS is best managed with which of the following agents?
Answer: Benzodiazepines plus nitroglycerin; avoid beta-blockers
Cocaine-induced ACS is treated with benzodiazepines (to reduce sympathetic drive) and nitrates; non-selective beta-blockers are contraindicated as they can cause unopposed alpha-adrenergic coronary vasospasm.
A 64-year-old woman is diagnosed with Takotsubo (stress) cardiomyopathy after an emotional stressor. Which angiographic finding distinguishes this from anterior STEMI?
Answer: Apical ballooning with normal or non-obstructive coronary arteries
Takotsubo cardiomyopathy shows apical LV ballooning with hypercontractile base on ventriculography, with absent or non-obstructive coronary artery disease on angiography, distinguishing it from anterior STEMI.