Diagnosis and ECG
This ECG finding in a patient with chest pain may indicate de Winter syndrome and warrants immediate cath lab activation.
What is upsloping ST depression at the J-point in V1-V4 with tall, peaked T waves? (Slides)
These antiplatelet agents are preferred over clopidogrel in ACS patients without high bleeding risk.
What is ticagrelor or prasugrel? (Slides)
Door-to-balloon time should be.
What is ≤90 minutes?
Morphine is cautioned against in ACS due to its effect on this drug interaction.
What is delayed absorption of oral P2Y12 inhibitors?
This intervention significantly reduces mortality and rehospitalization but is underutilized post-ACS.
What is cardiac rehabilitation?
The new guidelines prioritize this diagnostic modality for low-to-intermediate risk chest pain patients to reduce unnecessary admissions.
What is coronary CT angiography?
The recommended duration of dual antiplatelet therapy (DAPT) for most ACS patients is:
What is at least 12 months?
This arterial access is recommended to reduce bleeding and improve outcomes in PCI.
What is radial access?
This is the preferred imaging modality in pregnant patients with suspected ACS.
What is cardiac MRI (non-contrast)? (Slides)
2025 guidelines recommend targeting this LDL goal in high-risk ACS patients.
What is <55 mg/dL?
According to the 2025 update, which type of MI should not automatically trigger a full ACS protocol and cath lab activation?
What is Type 2 MI (secondary to supply-demand mismatch)?
For patients at high bleeding risk, this is the suggested minimum duration of DAPT.
What is 3 to 6 months?
Routine early PCI in NSTE-ACS patients is recommended within this time frame for high-risk features
What is within 24 hours?
This class of drugs (typically included in post-MI GDMT) is contraindicated in the immediate post-MI setting if there's evidence of hypotension or acute renal injury.
What are ACE inhibitors/ARBs?
These two medication classes are prioritized for diabetics post-ACS due to cardiovascular benefits.
What are SGLT2 inhibitors and GLP-1 receptor agonists?
The guidelines recommend this approach for diagnosing myocardial infarction in patients with left bundle branch block.
What is the use of the Sgarbossa criteria? (Slides)
Triple therapy with aspirin, P2Y12 inhibitor, and an anticoagulant is now discouraged unless the patient has this comorbidity.
What is atrial fibrillation with high CHA₂DS₂-VASc score and recent PCI? (Slides)
For cardiogenic shock, this support device is not routinely recommended in the 2025 update.
What is intra-aortic balloon pump (IABP)? (Slides)
Elderly patients over age 75 may be at higher risk of bleeding with this common antithrombotic strategy.
What is DAPT with ticagrelor or prasugrel?
This lifestyle intervention has the largest mortality benefit across all risk groups.
What is smoking cessation?
This type of MI often presents without classic ST elevations and is diagnosed by elevated troponins, ischemic symptoms, and angiographic evidence of plaque rupture or thrombus, despite initially “normal” ECG findings. This classification system is used to stratify the risk of bleeding in patients undergoing antithrombotic therapy.
What is NSTEMI (Non–ST Elevation Myocardial Infarction)?
The guidelines advise against the routine use of this analgesic in ACS due to potential adverse outcomes.
What is morphine?
Multivessel PCI is no longer routine in STEMI unless this condition is met.
What is cardiogenic shock or staged PCI for residual ischemia? (Slides)
Despite nonobstructive coronary arteries on cath, patients with this ACS mimic can still be managed per ACS guidelines.
What is MINOCA (Myocardial Infarction with Non-Obstructive Coronary Arteries)?
Beta blockers should be continued post-MI for this duration in patients without LV dysfunction or angina.
What is 3 years?