T1: Post ACS Treatment Tutoring By Alaina Darby

A bit more on immediate therapy… Anti-ischemic Reperfusion

Which of the following should DR not receive? SL Nitroglycerin DR is a 76 yo WM who presents to the ED with chest pain that is diagnosed as STEMI. PMH: diabetes, HTN Vitals/Labs: BP 120/70, HR 96, K 5.1 Which of the following should DR not receive? SL Nitroglycerin IV Nitroglycerine IV morphine PO Metoprolol PO Verapamil D

Why should DR not receive metoprolol? Age >70 SBP <140 DR is a 76 yo WM who presents to the ED with chest pain that is diagnosed as STEMI. PMH: diabetes, HTN Vitals/Labs: BP 120/70, HR 96, K 5.1 Why should DR not receive metoprolol? Age >70 SBP <140 HR <100 Diabetes A

Which may increase mortality in DR? SL Nitroglycerin IV Nitroglycerine DR is a 76 yo WM who presents to the ED with chest pain that is diagnosed as STEMI. PMH: diabetes, HTN Vitals/Labs: BP 120/70, HR 96, K 5.1 Which may increase mortality in DR? SL Nitroglycerin IV Nitroglycerine IV morphine PO Metoprolol PO Verapamil C

DR is a 76 yo WM who presents to the ED with chest pain that is diagnosed as STEMI. PMH: diabetes, HTN Vitals/Labs: BP 120/70, HR 96, K 5.1 Which of the following could be considered an alternative to a beta blocker, since in DR a beta blocker shouldn’t be used? SL Nitroglycerin IV Nitroglycerine IV morphine PO Metoprolol PO Verapamil E

Which of the following would most likely be added to DR’s regimen? DR is a 76 yo WM who presents to the ED with chest pain that is diagnosed as STEMI. PMH: diabetes, HTN Vitals/Labs: BP 120/70, HR 96, K 5.1 Which of the following would most likely be added to DR’s regimen? Lisinopril Carvedilol Verapamil Spironolactone C

What is the door to needle time for tPA? <30 minutes <60 minutes <90 minutes <120 minutes A

What is the door to balloon time for PCI? <30 minutes <60 minutes <90 minutes <120 minutes C

Which of the following is not evidence of successful reperfusion? Relief of chest pain Resolution of ST segment changes Reperfusion arrhythmias Early trough of troponin D

Which of the following patients would be indicated for thrombolytics? 78 yo M with STEMI, presents 6 hours after onset of chest pain, BP 170/100, TIA 6 months prior 22 yo M with NSTEMI, presents 14 hours after onset of chest pain, BP 190/100, no history of TIA 78 yo M with NSTEMI, presents 18 hours after onset of chest pain, BP 170/120, no history of TIA 22 yo M with STEMI, presents 3 hours after onset of chest pain, BP 160/125, no history of TIA A

Which of the following should be given peri-procedurally for PCI? UFH with tirofiban with both infusing for 18-24 hours post procedure UFH with bivalirudin 200 mg load of clopidogrel with 75 mg/day for 12 months 180 mg load of ticagrelor with 90 mg/day for 12 months 60 mg load of prasugrel with 10 mg/day for 12 months ASA 81 mg/day indefinitely E

Stents There was a question about stents last year, so be sure to look over that!! A

Which patient’s RAAS regimen is most indicated? Valsartan for a patient with STEMI and no comorbidities Valsartan for a patient with NSTEMI and no comorbidities Lisinopril for a patient with STEMI and no comorbidities Lisinopril for a patient with NSTEMI and no comorbidities C

Case: FG is a 48 yo WM who presented to the ED with chest pain that was determined to be NSTEMI. PMH: CHF (EF 52), DM SH: smokes ½ ppd, drinks 8 beers/week, denies elicit drug use FH: father died of MI at age 45 Vitals/Labs: K: 6 BP: 140/90 HR: 85

Labetolol, ASA 81 mg, Ticagrelor 90 mg BID FG is a 48 yo WM who presented to the ED with chest pain that was determined to be NSTEMI. PMH: CHF (EF 52), DM SH: smokes ½ ppd, drinks 8 beers/week, denies elicit drug use FH: father died of MI at age 45 Vitals/Labs: K+ 6, BP 140/90, HR 85 What medications should he receive chronically if he does not under go PCI? Labetolol, ASA 81 mg, Ticagrelor 90 mg BID Labetolol, ASA 81 mg, Prasugrel 10 mg Metoprolol, ASA 81 mg, Ticagrelor 90 mg BID Metoprolol, ASA 81 mg, Prasugrel 10 mg C… Labetalol has ISA

Metoprolol, ASA 81 mg, Ticagrelor 90 mg BID, Lisinopril FG is a 48 yo WM who presented to the ED with chest pain that was determined to be NSTEMI. PMH: CHF (EF 52), DM SH: smokes ½ ppd, drinks 8 beers/week, denies elicit drug use FH: father died of MI at age 45 Vitals/Labs: K+ 6, BP 140/90, HR 85 What medications should he receive chronically if he does under go PCI? Metoprolol, ASA 81 mg, Ticagrelor 90 mg BID, Lisinopril Metoprolol, ASA 81 mg, Prasugrel 10 mg, Lisinopril Metoprolol, ASA 81 mg, Ticagrelor 90 mg BID Metoprolol, ASA 81 mg, Prasugrel 10 mg BID C… look at K+!

Metoprolol, ASA 81 mg, Ticagrelor 90 mg BID, Lisinopril FG is a 48 yo WM who presented to the ED with chest pain that was determined to be NSTEMI. PMH: CHF (EF 52), DM SH: smokes ½ ppd, drinks 8 beers/week, denies elicit drug use FH: father died of MI at age 45 Vitals/Labs: K+ 6, BP 140/90, HR 85 FG’s K+ decreases to 3.4 once stabilized. Now, what medications should he receive chronically if he did not under go PCI? Metoprolol, ASA 81 mg, Ticagrelor 90 mg BID, Lisinopril Metoprolol, ASA 81 mg, Prasugrel 10 mg, Lisinopril Metoprolol, ASA 81 mg, Ticagrelor 90 mg BID Metoprolol, ASA 81 mg, Prasugrel 10 mg BID A

FG is a 48 yo WM who presented to the ED with chest pain that was determined to be NSTEMI. PMH: CHF (EF 52), DM SH: smokes ½ ppd, drinks 8 beers/week, denies elicit drug use FH: father died of MI at age 45 Vitals/Labs: K+ 6, BP 140/90, HR 85 FG’s K+ decreases to 3.4 once stabilized. Why should he receive an ACEi? CHF HTN DM HR >75 C

FG is a 48 yo WM who presented to the ED with chest pain that was determined to be NSTEMI. PMH: CHF (EF 52), DM SH: smokes ½ ppd, drinks 8 beers/week, denies elicit drug use FH: father died of MI at age 45 Vitals/Labs: K+ 6, BP 140/90, HR 85 FG’s K+ decreases to 3.4 once stabilized. Which of the following would not confer mortality benefits post-MI? Metoprolol ASA Lisinopril NTG D

Case: HR is a 65 yo AAM who presented to the ED with chest pain that was determined to be STEMI. PMH: CHF (EF 38) Vitals/Labs: K+: 3.9 BP: 120/80 HR: 45

HR is a 65 yo AAM who presented to the ED with chest pain that was determined to be STEMI. PMH: CHF (EF 38) Vitals/Labs: K+ 3.9, BP 120/80, HR 45 What medications should he receive chronically if he does under go PCI? ASA 81 mg, Ticagrelor 90 mg BID ASA 81 mg, Prasugrel 10 mg, Lisinopril Metoprolol, ASA 81 mg, Ticagrelor 90 mg BID, Lisinopril Metoprolol, ASA 81 mg, Prasugrel 10 mg BID, Lisinopril B… look at HR!!

HR is a 65 yo AAM who presented to the ED with chest pain that was determined to be STEMI. PMH: CHF (EF 38) Vitals/Labs: K+ 3.9, BP 120/80, HR 45 HR develops a dry cough, which should be used instead of Lisinopril? Candesartan Losartan Olmesartan Why can’t they use Lisinopril? A

HR is a 65 yo AAM who presented to the ED with chest pain that was determined to be STEMI. PMH: CHF (EF 38) Vitals/Labs: K+ 3.9, BP 120/80, HR 45 Which of the following should be added due to his CHF? Lisinopril Eplenerone ASA A&B All of the above D… ASA is for EVERYONE!!