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Chapter 8. Acute Coronary Syndromes

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?

A. Location of the coronary artery blockade

B. Quality of chest discomfort

C. Severity of coronary artery disease

D. Elevated plasma troponin concentration

E. ECG changes

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?

A. Aspirin 325 mg and clopidogrel 75 mg daily

B. Aspirin 325 mg and ticagrelor 90 mg twice daily

C. Aspirin 325 mg and prasugrel 10 mg daily

D. Aspirin 81 mg and prasugrel 10 mg daily

E. Aspirin 81 mg and ticagrelor 90 mg twice daily

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?

A. Fibrinolytic therapy

B. An early invasive strategy

C. A delayed invasive strategy

D. An ischemia-guided approach

E. A percutaneous strategy

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?

A. Clopidogrel, UFH, abciximab

B. Ticagrelor, enoxaparin, eptifibatide

C. Prasugrel, fondaparinux

D. Ticagrelor, UFH

E. Clopidogrel, bivalirudin, tirofiban

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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