Acute Myocardial Infarction

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Acute Myocardial Infarction

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Questions and Answers
  • 1. 
    • A. 

      Thrombolytic therapy has been studied in patients with ECG findings other than ST-segment elevation or bundle branch block and has been found to be superior to conventional therapy

    • B. 

      Current recommendations are that the time between a patient's presentation to the emergency department and the administration of thrombolytic therapy not exceed 2 hours

    • C. 

      Coronary angiography is recommended in all patients after thrombolytic therapy has been administered, once they become hemodynamically stable

    • D. 

      Streptokinase therapy is contraindicated in patients who have recently received a dose of streptokinase because of antibodies that form against the drug

  • 2. 
    A 49-year-old white man who presented to the emergency department with an ST-segment elevation myocardial infarction was given thrombolytics, oxygen, and aspirin. He is now free of chest pain and will be admitted to the coronary care unit for further monitoring.   Which of the following statements regarding adjuvant medical therapy for acute myocardial infarction is false?
    • A. 

      Early administration of beta blockers reduces the mortality and the reinfarction rate

    • B. 

      Unless contraindicated, angiotensin-converting enzyme (ACE) inhibitors are indicated in patients with significant ventricular dysfunction after acute myocardial infarction

    • C. 

      When given within 6 hours after presentation to the hospital, I.V. nitroglycerin reduces mortality in patients with myocardial infarction

    • D. 

      Prophylactic therapy with lidocaine does not reduce and may actually increase mortality because of an increase in the occurrence of fatal bradyarrhythmia and asystole

  • 3. 
    A 49-year-old white woman was admitted last night with an acute ST-segment elevation myocardial infarction. She underwent left heart catheterization with restoration of blood flow to her left circumflex artery and is currently in the CCU. She has received anticoagulation therapy and has been started on an ACE inhibitor, aspirin, and a beta blocker.   Which of the following statements regarding possible complications of acute myocardial infarction is true?
    • A. 

      The Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) trial showed that rhythm-control strategies provided a significant survival advantage when compared with rate-control strategies

    • B. 

      Beta blockers may reduce the early occurrence of ventricular fibrillation

    • C. 

      Severe mitral regurgitation is 10 times more likely to occur with anterior myocardial infarction than with inferior myocardial infarction

    • D. 

      When patients have right ventricular infarction, the left ventricle is almost always spared of any damage

  • 4. 
    A 55-year-old man with a history of hypertension and hyperlipidemia presents to the emergency department with chest pain for the past 4 hours. His symptoms started while he was playing racquetball. The pain is crushing, retrosternal, 9/10 in severity, and radiating to the left arm. It is worse with exertion and associated with mild shortness of breath. In the emergency department, the patient is given aspirin, nitroglycerin, and oxygen and experiences moderate symptomatic improvement. His electrocardiogram shows ST segment elevation in the anterior precordial leads with reciprocal changes inferiorly.   Which of the following is the most important next step in the management of this patient?
    • A. 

      Thrombolytic therapy

    • B. 

      Percutaneous coronary intervention (PCI)

    • C. 

      Send cardiac biomarkers

    • D. 

      Intravenous morphine

  • 5. 
    A 50-year-old woman is hospitalized for an acute inferior myocardial infarction for which she has undergone angioplasty to the right coronary artery. On day 4, she develops acute shortness of breath and hypotension. She does not have any chest pain. On examination, she is tachycardic with a 3/6 holosystolic murmur at the apex and bibasilar crackles. An electrocardiogram shows sinus tachycardia, and a chest x-ray shows pulmonary edema.   Which of the following is the most appropriate management for this patient’s problem?  
    • A. 

      Prompt surgical repair

    • B. 

      Left heart catheterization

    • C. 

      Right heart catheterization

    • D. 

      Anticoagulation

  • 6. 
    A 65-year-old man with diabetes, hyperlipidemia, and tobacco abuse presents to the emergency department with chest pain for the past 3 days. The pain is worse with exertion and was relieved by sublingual nitroglycerin until today, when the pain persisted. It radiates to the jaw and is associated with nausea and diaphoresis. On examination, the blood pressure is 90/50 mm Hg, with a heart rate of 95 beats perminute. He has a 2/6 holosystolic murmur at the right lower sterna border and a jugular venous pressure of 12 mm H2O. An electrocardiogram reveals ST segment depressions in the inferior leads. CK-MB and troponin levels are elevated, and the patient is diagnosed with a non–ST segment elevation myocardial infarction.   Which of the following medications should be avoided in the management of this patient?
    • A. 

      Heparin

    • B. 

      Aspirin

    • C. 

      Nitrates

    • D. 

      Angiotensin-converting enzyme inhibitor

  • 7. 
    A 60-year-old female with a history of coronary artery disease presents to a rural emergency department with chest pain for 1 hour. Her pain is similar to the symptoms that she experienced last year when she was diagnosed with a non–ST elevation myocardial infarction. She has been taking her medications as instructed. The electrocardiogram shows anterior ST segment elevations. The nearest catheterizationlaboratory is 3 hours away.   Which of the following is the most appropriate next step in the management of this patient?
    • A. 

      Transfer the patient for PCI

    • B. 

      Consult Cardiovascular Surgery for coronary bypass surgery

    • C. 

      Administer thrombolytics if there are no contraindications

    • D. 

      Medical management

  • 8. 
    A 40-year-old male has been in the hospital for 5 days following an acute myocardial infarction. His catheterization revealed 99% stenosis of the left circumfl ex, and he received one drug-eluting stent without complications. An echocardiogram showed an ejection fraction of 55%. His current medications include aspirin, clopidrogel, and metoprolol.   Which of the following medications should be added to this patient’s regimen prior to discharge?
    • A. 

      An angiotensin receptor blocker

    • B. 

      Warfarin

    • C. 

      Furosemide

    • D. 

      Statin