CMC Cardiac Medicine Certification

Acute Coronary Syndrome (ACS): any group of clinical symptoms resulting from acute myocardial ischemia. platelet activation of the coagulation cas- cade and the formation of a thrombus over the injured area ensues ACS is divided into three categories: unstable angina (USA) Non-STEMI No evidence of ST elevation. STEMI Risk factors for ACS include: Myocardial ischemia is characterized by Infarction is characterized by a Q wave duration of 0.04 seconds or longer. 40% to 50% of MIs involve the INFERI- OR WALL begins with the rupture of atherosclerotic plaque, creating an injured area on the endothelium. restricted blood flow, cardiac ischemia and chest pain, the most common symptom of ACS. unstable angina (USA) Non ST segment elevation MI (NSTEMI) ST segment elevation MI (STEMI). no rise in cardiac biomarkers. If there is a decrease in left ventricular function sec- ondary to cardiac ischemia, it returns to normal after the ischemia has resolved. Cardiac biomarker levels rise but the lev- els will not be high enough to render a positive test result. May be left ventricular dysfunction after NSTEMI resolves ST elevations will be present in different leads depending on injury location; a Q wave may be present. CK-MB and tro- ponin are positive; high risk for left ventricular dysfunction. CAD, atherosclerotic plaque on the walls of the arteries; age >55, Male; smoking, obesity, HTN, ETOH, hypercholesterolemia, sedentary lifestyle; uncontrolled DM T-wave inversion on an ECG. The Q wave will also be approximately one-fourth to one-third the height of the R wave. In 80% of patients, the inferior wall is supplied by the RCA via the posterior descending artery (Right-dominance). Good prognosis (<10% mortality)