SELF ASSESSMENT-ACS
MedEducation Flix – ACS Self-Assessment
🫀 Acute Coronary Syndrome (ACS) – Quiz
1. What are the three clinical syndromes under the ACS umbrella?
STEMI, NSTEMI, and Unstable Angina.
2. What differentiates NSTEMI from unstable angina?
NSTEMI has elevated cardiac biomarkers; unstable angina does not.
3. What defines type 2 myocardial infarction?
Myocardial injury from oxygen supply–demand mismatch, not plaque rupture.
4. What is MINOCA?
Myocardial infarction with non-obstructive coronary arteries (<50% stenosis).
5. What is the universal definition of myocardial infarction?
Rise/fall in troponin with one value above the 99th percentile, plus ischemic evidence.
6. Which ECG findings are diagnostic of STEMI?
ST elevation ≥1 mm in ≥2 contiguous leads, or new LBBB with symptoms.
7. What ECG changes suggest posterior MI?
ST depression in V1–V3, tall R waves; confirm with V7–V9.
8. What is Wellens’ syndrome?
Deep or biphasic T waves in V2–V3, suggestive of critical LAD stenosis.
9. What does the de Winter T-wave pattern indicate?
Upsloping ST depression with peaked T waves in precordial leads – proximal LAD occlusion.
10. What ECG finding suggests left main coronary artery ischemia?
ST elevation in aVR with widespread ST depression.
11. Which biomarker is most specific for myocardial injury?
High-sensitivity troponin (hs-cTnT or hs-cTnI).
12. What conditions may elevate troponin without ACS?
Heart failure, myocarditis, renal failure, sepsis, PE.
13. What are the major risk scores in ACS?
GRACE, TIMI, and HEART score.
14. What HEART score indicates high risk?
Score ≥7 suggests high risk for MACE.
15. How is serial troponin used in low-risk chest pain?
Negative troponins 1–3 hours apart can rule out AMI.
16. What is the immediate treatment bundle in suspected ACS?
Aspirin, nitrates, oxygen if hypoxic, IV access, ECG, and monitoring.
17. When are nitrates contraindicated?
Hypotension, RV infarct, or recent PDE-5 inhibitor use.
18. What is the P2Y12 inhibitor of choice in STEMI?
Ticagrelor or prasugrel preferred; clopidogrel if others contraindicated.
19. When is fibrinolysis appropriate?
STEMI without PCI access within 120 minutes.
20. What are absolute contraindications to fibrinolysis?
Active bleeding, prior ICH, known AVM, recent stroke or trauma.
21. What is the ideal door-to-balloon time?
≤90 minutes from hospital arrival.
22. What should be administered before PCI?
Aspirin, P2Y12 inhibitor, heparin or bivalirudin; consider GPIIb/IIIa inhibitor.
23. When is early invasive strategy used in NSTEMI?
High-risk features: GRACE >140, ECG changes, troponin rise.
24. How is failed fibrinolysis defined?
<50% ST resolution in 90 min, ongoing pain, or instability.
25. What is rescue PCI?
PCI after failed fibrinolysis.
26. What drugs reduce mortality post-MI?
Aspirin, P2Y12 inhibitor, statin, beta-blocker, ACE inhibitor.
27. What statin therapy is preferred post-ACS?
High-intensity statins: atorvastatin 80 mg or rosuvastatin 20–40 mg.
28. When is prolonged DAPT considered?
High ischemic risk and low bleeding risk.
29. When is eplerenone used post-MI?
LVEF <40% with heart failure or diabetes.
30. When should beta-blockers be avoided?
Hypotension, bradycardia, heart failure, or asthma.
31. How can ACS present atypically?
Dyspnea, fatigue, syncope—especially in elderly and diabetics.
32. What are signs of RV infarction?
Hypotension, clear lungs, elevated JVP, ST elevation in V4R.
33. What imaging is useful in MINOCA?
Cardiac MRI to differentiate infarct, myocarditis, takotsubo.
34. How is perioperative MI managed?
Treat as type 2 unless clear ST elevation or plaque rupture.
35. Name 3 ECG mimics of STEMI.
Pericarditis, early repolarisation, hyperkalemia.
36. Name 3 mechanical complications of STEMI.
Free wall rupture, papillary muscle rupture, VSD.
37. How is cardiogenic shock managed in MI?
Urgent revascularisation, vasopressors, mechanical support.
38. What defines reinfarction?
Recurrent pain + new ECG changes or second troponin rise.
39. When should you suspect stent thrombosis?
Sudden arrest or ST elevation post-PCI in same territory.
40. What is the role of CTCA in ACS?
Rule-out tool in low-risk patients with normal ECG and negative troponins.