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Chapter 8. Acute Coronary Syndromes

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A 68-year-old man with a history of ischemic heart disease develops severe chest pain (8/10 on a pain scale) with subsequent ECG depression in leads II, III, and aVF. Serum creatinine is 1.0 mg/dL (88 μmol/L) and troponin I is 3.4 ng/mL (3.4 mcg/L; 3400 ng/L). Which of the following differentiates MI from UA in this patient?

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A. Location of the coronary artery blockade

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B. Quality of chest discomfort

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C. Severity of coronary artery disease

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D. Elevated plasma troponin concentration

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E. ECG changes

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A 76-year-old man with prior history of coronary artery disease, hypertension, hyperlipidemia and stroke is found to have STEMI and receives a DES. Which dual antiplatelet regimen is most appropriate for him to receive at time of discharge?

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A. Aspirin 325 mg and clopidogrel 75 mg daily

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B. Aspirin 325 mg and ticagrelor 90 mg twice daily

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C. Aspirin 325 mg and prasugrel 10 mg daily

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D. Aspirin 81 mg and prasugrel 10 mg daily

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E. Aspirin 81 mg and ticagrelor 90 mg twice daily

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An 82-year-old man with STEMI was brought by ambulance to a small community hospital during nighttime (off-peak) hours. The nearest hospital with operating catheterization facilities is a 2.5-hour distance away. Which of the following addresses the appropriate reperfusion for this patient?

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A. Fibrinolytic therapy

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B. An early invasive strategy

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C. A delayed invasive strategy

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D. An ischemia-guided approach

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E. A percutaneous strategy

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A 54-year-old woman with a CrCl of 20 ml/min (0.33 mL/s) is being treated for ACS by utilizing an ischemia-guided strategy. In addition to aspirin 81 mg daily, which of the following medication combinations is most appropriate in this patient?

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A. Clopidogrel, UFH, abciximab

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B. Ticagrelor, enoxaparin, eptifibatide

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C. Prasugrel, fondaparinux

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D. Ticagrelor, UFH

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E. Clopidogrel, bivalirudin, tirofiban

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A 62-kg (137-lb) man with CrCl of 55 mL/min (0.92 mL/s) is found to have a NSTE-ACS. Troponin levels, drawn at three separate intervals, are all ...

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