Non–ST-Elevation Acute Coronary Syndromes

Non–ST-Elevation Acute Coronary Syndromes
Order 5892561
Non–ST-Elevation Acute Coronary Syndromes
A 65-year-old man with a history of hyperlipidemia
presents to the emergency room with 2 hours of
chest heaviness. His electrocardiogram (EKG) reveals sinus rhythm with anterolateral ST-segment
depressions. His physical examination and initial
blood work are unremarkable. He is diagnosed with
non–ST-elevation acute coronary syndrome (ACS)
and preparations are being made to perform coronary
angiography in the next hour. His only medication
is atorvastatin 20 mg daily. What antiplatelet agents
should be administered to him?
(A) Aspirin and abciximab
(B) Aspirin, clopidogrel 600 mg, and plans for abciximab if a decision is made to proceed to
percutaneous coronary intervention (PCI)
(C) Aspirin and eptifibatide
(D) Aspirin and plans for abciximab if a decision is
made to proceed to PCI
(E) Aspirin, clopidogrel 600 mg, and eptifibatide
2 A 54-year-old woman with a history of type 2 diabetes on metformin is being transferred to undergo
urgent coronary angiography and possible PCI after
being diagnosed with non–ST-elevation myocardial
infarction (NSTEMI) at an outside facility. She arrives in the catheterization laboratory without ongoing chest pain and no signs of heart failure. The
onset of chest pain was 8 hours ago, and the cardiac biomarkers from the outside facility are positive. Serum creatinine is normal. She received aspirin
325 mg and enoxaparin 1 mg per kg SQ at the outside
hospital 8 hours ago. Coronary angiography reveals
mid-LAD culprit lesion with a severe thrombotic
stenosis. What is the optimal anticoagulation strategy
during the upcoming PCI?
Non–ST-Elevation Acute Coronary Syndromes
(A) No further heparin
(B) Enoxaparin 0.3 mg per kg IV
(C) Unfractionated intravenous heparin
3 A 41-year-old man with a past medical history of
asthma presents to the emergency department with
an acute onset of severe retrosternal discomfort
approximately 10 hours ago. His echocardiogram
reveals sinus tachycardia and nonspecific T-wave
changes. Which of the following are appropriate
cardiac biomarkers to assist in risk stratification?
(A) Creatine kinase (CK), creatine kinase–myocardial band (CK-MB), and a cardiac-specific troponin
(B) Myoglobin only
(C) C-reactive protein and myoglobin
(D) Myeloperoxidase and aspartate aminotransferase (AST)
(E) CK without CK-MB and a cardiac-specific troponin
4 A 71-year-old man with a history of coronary artery disease and prior coronary artery bypass
graft (CABG) surgery presents to the emergency department with chest discomfort and dyspnea. The
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Practice Guidelines in Non–ST-Elevation Acute Coronary Syndromes 289
symptoms started approximately 5 hours before his
arrival. On physical examination, blood pressure
(BP) is 95/55 mm Hg and heart rate (HR) is 110
bpm. Pulsoximetry reveals 88% on room air. The patient is diaphoretic. He has elevated jugular venous
pulsations and bilateral wet crackles midway up the
lung fields. His cough is productive of pink sputum.
His EKG reveals sinus tachycardia with anterolateral
T-wave inversions. His outpatient medications are
aspirin and simvastatin. He is diagnosed with unstable angina. In this patient’s presentation, which of
the following portends the highest short-term risk of
death or myocardial infarction (MI)?
(A) Age >70 years
(B) History of a prior CABG surgery
(C) Pulmonary edema most likely because of ischemia
(D) History of prior aspirin use
(E) T-wave inversions on the EKG
5 Which of the following anti-ischemic medications
does not have an American College of Cardiology/
American Heart Association (ACC/AHA) Class I
indication for patients with non–ST-elevation ACS?
Non–ST-Elevation Acute Coronary Syndromes
(A) Nitroglycerin
(B) Morphine sulfate
(C) ACE inhibitor
(D) β-adrenergic antagonist.
(E) Dihydropyridine calcium channel blocker
6 Which of the following antiplatelet or anticoagulant
medications does not have an ACC/AHA Class I
indication for patients with non–ST-elevation ACS?
(A) Low molecular weight heparin (LMWH) subcutaneously
(B) Unfractionated heparin intravenously
(C) Fondaparinux
(D) Aspirin
(E) Clopidogrel for patients who have a documented
allergy to aspirin
7 A 68-year-old man with no previous history of bleeding sustains an NSTEMI and undergoes coronary
angiography that reveals a recanalized right coronary artery (RCA) culprit lesion with only mild
residual stenosis. No PCI is performed. His echocardiogram reveals normal ventricular function. His
BP is 106/68 mm Hg. A lipid profile reveals total
cholesterol of 214 mg per dL, high-density lipoprotein (HDL) of 50 mg per dL, low-density lipoprotein
(LDL) of 140 mg per dL, triglycerides of 120 mg per
dL. He is discharged home on aspirin and atorvastatin. Should he also be prescribed clopidogrel?
(A) No
(B) Yes, for 1 month
(C) Yes, for 9 months
(D) Yes, for 2 years
(E) Yes, indefinitely
8 A 72-year-old woman with a previous history of
CABG surgery and severe dementia is admitted to
the hospital with unstable angina. Her EKG reveals
sinus rhythm and dynamic ST depressions. Her HR
is 64 bpm and BP is 110/55 mm Hg. Her troponin T
level is 0.05 ng per mL. She and her family adamantly
refuse cardiac catheterization. She is started on
aspirin, enoxaparin, simvastatin, IV nitroglycerin,
and IV metoprolol. She denies any chest discomfort
at present. To improve her medical regimen:
(A) Add abciximab
(B) Add eptifibatide
(C) Add tirofiban
(D) Add clopidogrel
(E) Substitute enoxaparin with unfractionated heparin
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