Evidence-Based Cardiology: Acute Coronary Syndromes

1. Question

What combination of parameters is recommended for the diagnosis and initial short-term risk stratification of acute coronary syndrome (ACS)?

Clinical history, symptoms, vital signs, physical findings, ECG, and hs-cTn.
Only clinical history and ECG.
Symptoms, vital signs, and ECG.
Vital signs, ECG, and chest X-ray.
Clinical history, symptoms, and systolic blood pressure.

2. Question

What is the recommended target time for recording and interpreting a 12-lead ECG at the point of first medical contact (FMC) for patients with suspected acute coronary syndrome?

<5 minutes
<10 minutes
<15 minutes
<20 minutes
<30 minutes

3. Question

In patients with suspected acute coronary syndrome (ACS), when is continuous ECG monitoring and the availability of defibrillator capacity recommended?

Only after the diagnosis of myocardial infarction (MI) is confirmed
Only in patients with ongoing chest pain
Only in patients with suspected STEMI
As soon as possible in all patients with suspected STEMI, in suspected ACS with other ECG changes or ongoing chest pain, and once the diagnosis of MI is made
Only in patients with suspected ACS (STEMI, NSTEMI, UA) and no ECG changes

4. Question

In cases of suspected acute coronary syndrome, when is the use of additional ECG leads (V3R, V4R, and V7-V9) recommended?

When there are signs of anterior STEMI on standard leads.
When there are signs of inferior STEMI or total vessel occlusion is suspected and standard leads are inconclusive.
When there are signs of lateral STEMI on standard leads.
When there are no ST-T changes detected on standard leads.
When the patient has a history of previous myocardial infarctions.

5. Question

In patients with suspected acute coronary syndrome, what is recommended in cases with recurrent symptoms or diagnostic uncertainty?

A chest X-ray
An echocardiogram
A stress test
An additional 12-lead ECG
Cardiac MRI

6. Question

What is recommended regarding the measurement of cardiac troponins in patients with suspected acute coronary syndrome?

To measure cardiac troponins with standard-sensitivity assays and obtain the results within 30 minutes of blood sampling.
To measure cardiac troponins with high-sensitivity assays immediately after presentation and obtain the results within 60 minutes of blood sampling.
To measure cardiac troponins with high-sensitivity assays within 1 hour of presentation and obtain the results within 60 minutes of blood sampling.
To measure cardiac troponins with standard-sensitivity assays immediately after presentation and obtain the results within 60 minutes of blood sampling.
To measure cardiac troponins with high-sensitivity assays immediately after presentation and obtain the results within 120 minutes of blood sampling.

7. Question

What is the recommended approach to rule in and rule out NSTEMI in patients with suspected acute coronary syndrome according to the guideline?

Use an ESC algorithmic approach with serial hs-cTn measurements (0 h/1 h or 0 h/2 h)
Use a single hs-cTn measurement at 3 hours
Use a single hs-cTn measurement at 2 hours
Use a single hs-cTn measurement at 1 hour
Use a 12-lead ECG immediately upon presentation and hs-cTn within 1 hour of presentation.

8. Question

What is recommended if the first two hs-cTn measurements of the 0 h/1 h algorithm are inconclusive and no alternative diagnoses explaining the condition have been made?

It is safe to discharge the patient
Additional hs-cTn testing after 3 hours
Referral to myocardial perfusion scintigraphy
Initiation of antiplatelet agent (initially aspirin)
Repeat the initial hs-cTn measurements

9. Question

In patients with suspected acute coronary syndrome, what is recommended for prognosis estimation?

Killip class
CCS score
The use of established risk scores (e.g. GRACE risk score)
Assessment of hemodynamic status
Hs-cTn levels

10. Question

A 60-year-old woman with a history of hypertension and hyperlipidemia presents to the emergency department with a sudden onset of severe, crushing chest pain that began 45 minutes ago. An electrocardiogram (ECG) performed upon arrival shows significant ST-segment elevation in the inferior leads.

What immediate management strategy should be pursued for this patient with suspected ST-elevation myocardial infarction (STEMI)?

Patient should be monitored closely.
Patients should be scheduled for a follow-up appointment within 24 hours.
Patients should receive emergency reperfusion therapy after confirming diagnosis with multiple tests.
Patients with suspected STEMI are immediately triaged for an emergency reperfusion strategy.
Patients with suspected STEMI are immediately triaged for primary PCI.

11. Question

In patients with suspected acute coronary syndrome presenting with cardiogenic shock or suspected mechanical complications, what is recommended?

A 70-year-old male with a history of coronary artery disease presents to the emergency department with severe chest pain and profound shortness of breath that began three hours ago. On examination, he is pale and clammy. His blood pressure is 80/50 mmHg, heart rate is 120 beats per minute, and oxygen saturation is 88% on room air. Jugular venous distension is noted, and lung auscultation reveals bilateral crackles. A systolic murmur is also noted. An ECG shows ST-segment elevation in the anterior leads. The patient is immediately transferred to the PCI laboratory.

What is recommended for this patient, in addition to primary PCI?

1. Emergency TTE
2. Emergency TEE (TOE)
3. Emergency CT scan (coronary arteries, aorta, pulmonary arteries)
4. Emergency MRI scan
5. Emergency angiography

12. Question

In patients with suspected acute coronary syndrome (ACS), non-elevated (or uncertain) hs-cTn levels, no ECG changes, and no recurrence of pain, which test should be considered as part of the initial workup?

1. Echocardiography
2. Coronary CT angiography (CCTA)
3. Cardiac MRI with perfusion
4. Myocardial perfusion scintigraphy
5. Intravascular Ultrasound (IVUS)

13. Question

In patients with suspected acute coronary syndrome, under what circumstances should emergency TTE be considered?

1. In all cases
2. Only in cases where there is a clear diagnosis
3. At triage in cases of diagnostic uncertainty
4. After transfer to the cardiac catheterization laboratory
5. If there is no suspicion of an acute coronary artery occlusion

14. Question

In the initial assessment of patients with suspected acute coronary syndrome (ACS), which of the following is NOT recommended?

1. Routine, early CCTA
2. Routine, early ECG
3. Routine, early cardiac biomarkers
4. Routine, early echocardiogram
5. Routine, early stress testing

15. Question

In patients with acute coronary syndrome, at what level of SaO2 is oxygen administration recommended?

1. SaO2 <85%
2. SaO2 <88%
3. SaO2 <90%
4. SaO2 <92%
5. SaO2 <95%

16. Question

Which of the following is recommended for relieving pain in patients with acute coronary syndrome?

1. Intravenous acetaminophen
2. Inhaled nitrous oxide
3. Intravenous opioids
4. Intravenous lidocaine
5. Intravenous midazolam

17. Question

What should be considered for very anxious patients with acute coronary syndrome?

1. A mild analgesic
2. A mild tranquilizer
3. Beta-blocker
4. Opioid
5. Propofol

18. Question

A 55-year-old male presents to the emergency department with sudden onset chest pain. On arrival, his vital signs are stable with a blood pressure of 130/85 mmHg, heart rate of 85 beats per minute, and oxygen saturation of 98% on room air. An ECG shows ST-segment elevation in the inferior leads. He is promptly diagnosed with an anterior ST-elevation myocardial infarction (STEMI) and is being prepared for primary percutaneous coronary intervention (PPCI). He has no signs of acute heart failure.

What role should intravenous beta-blockers play at the time of presentation?

1. Intravenous beta-blockers (preferably metoprolol) should be considered
2. Oral beta-blockers should be considered
3. Intravenous calcium channel blockers should be considered
4. Oral ACE inhibitors are indicated
5. Intravenous nitrates are indicated

19. Question

In the initial management of patients with acute coronary syndrome, what is recommended for patients transferred for primary PCI?

1. They should be evaluated in the emergency department before being transferred to the catheterization laboratory.
2. They should be admitted to the CCU/ICU before undergoing catheterization.
3. They should bypass the emergency department and CCU/ICU and be transferred directly to the catheterization laboratory.
4. They should receive thrombolytic therapy before being transferred to the catheterization laboratory.
5. They should undergo a TTE before being transferred to the catheterization laboratory.

20. Question

In the initial management of patients with acute coronary syndrome, what is the recommended action for EMS when transporting patients with suspected STEMI?

1. Transfer to the nearest hospital.
2. Transfer to a center with cardiothoracic surgery.
3. Transfer to a PCI-capable center, bypassing non-PCI centers.
4. Transfer to a center with capability to perform PCI and cardiothoracic surgery.
5. Transfer to any hospital for stabilization before moving to a PCI-capable center.

21. Question

Which of the following is recommended for ambulance teams managing patients with acute coronary syndromes?

1. Ambulance teams should only transport patients to the nearest hospital.
2. Ambulance teams should be equipped to perform basic life support (BLS) measures.
3. Ambulance teams should administer initial therapy and transmit the ECG to a hospital for interpretation
4. Ambulance teams should identify ECG patterns suggestive of acute coronary occlusion and administer initial therapy, including defibrillation and fibrinolysis when applicable.
5. Ambulance teams should identify ECG patterns suggestive of acute coronary occlusion and administer initial therapy, including defibrillation.

22. Question

A 62-year-old female with no prior history of cardiac issues presents to the emergency department with acute onset chest pain that started six hours ago. The pain is described as intense and crushing, radiating to her left shoulder and jaw. She is also experiencing shortness of breath and nausea. On examination, her blood pressure is 145/90 mmHg, heart rate is 95 beats per minute, and oxygen saturation is 96% on room air. An electrocardiogram (ECG) shows persistent ST-segment elevation in the anterior leads.

What is the recommended management strategy for this patient?

1. Immediate coronary artery bypass graft surgery
2. Conservative management due to duration of symptoms
3. Reperfusion (PCI or fibrinolysis) therapy
4. Immediate anticoagulant therapy
4. Immediate antiplatelet therapy

23. Question

A 58-year-old male presents to the emergency department with sudden onset of severe chest pain that began 7 hours ago. An ECG reveals ST-segment elevation in the inferior leads. The hospital has a catheterization lab available, and the anticipated time from diagnosis to percutaneous coronary intervention (PCI) is estimated to be 110 minutes.

What reperfusion strategy should be recommended for this patient?

1. Fibrinolysis
2. CABG
3. Medical therapy
4. PPCI
5. None

24. Question

A 64-year-old male presents to the emergency department with severe chest pain that began five hours ago. On examination, his blood pressure is 145/85 mmHg, heart rate is 100 beats per minute, and oxygen saturation is 94% on room air. An ECG shows significant ST-segment elevation in the anterior leads. The nearest hospital can perform primary percutaneous coronary intervention (PPCI) at best within 125 minutes of diagnosis.

What is the recommended reperfusion strategy?

1. Antiplatelet therapy
2. Coronary artery bypass grafting
3. Fibrinolytic therapy
4. PPCI with readiness for fibrinolysis
5. PPCI

25. Question

Under which conditions is rescue PCI recommended for patients with STEMI after fibrinolysis?

1. When ST-segment resolution is less than 90% within 60-90 minutes of fibrinolytic administration, or in the presence of hemodynamic or electrical instability, worsening ischemia, or persistent chest pain
2. When ST-segment resolution is less than 50% within 60-90 minutes of fibrinolytic administration, or in the presence of hemodynamic or electrical instability, worsening ischemia, or persistent chest pain
3. When ST-segment resolution is less than 50% within 60-90 minutes of fibrinolytic administration
4. In the presence of hemodynamic or electrical instability, worsening ischemia, or persistent chest pain
5. When there is no improvement in symptoms after 24 hours of fibrinolytic administration

26. Question

In patients with a working diagnosis of STEMI and a time from symptom onset >12 hours, when is a PPCI strategy recommended?

1. In the presence of ongoing symptoms suggestive of ischaemia
2. In the presence of ongoing symptoms suggestive of ischaemia, haemodynamic instability, or life-threatening arrhythmias
3. Regardless of symptom presence or haemodynamic stability
4. Only if the patient is over 65 years old
5. In patients with no history of cardiovascular disease

27. Question

In patients with STEMI presenting 12 to 48 hours after symptom onset, what reperfusion strategy should be considered?

1. Thrombolytic therapy
2. Routine PPCI strategy
3. CABG
4. Conservative management
5. Elective PCI after 48 hours

28. Question

What is the recommendation for PCI of an occluded infarct-related artery (IRA) in STEMI patients presenting more than 48 hours after symptom onset and without persistent symptoms?

1. PCI is recommended
2. It is recommended only after resuscitation
3. It is not recommended.
4. PCI is recommended in the presence of additional risk factors.
5. It is recommended as a second-line treatment.

29. Question

A 58-year-old female with a history of hypertension presents to a hospital without PCI capabilities, experiencing severe chest pain and shortness of breath. Her ECG shows ST-segment elevation, and she receives fibrinolytic therapy within 90 minutes of symptom onset. ST-segment resolution is satisfactory and the patient is asymptomatic 60 minutes after infusion of the fibrinolytic agent.

What is the recommended subsequent step in the management of this patient?

1. Transfer to a non-PCI-capable center is acceptable
2. Immediate discharge home
3. Admission and observation
4. Transfer to a PCI-capable center
5. Start of anticoagulant therapy

30. Question

A 62-year-old male with a history of diabetes presents to the emergency department with severe chest pain and shortness of breath. His ECG shows ST-segment elevation, and he receives fibrinolytic therapy. Despite initial treatment, he develops signs of persistent heart failure and hypotension. His blood pressure drops to 85/60 mmHg, and he has significant pulmonary edema on auscultation.

What is the recommended next step in the management of this patient?

1. Repeat fibrinolysis therapy
2. Immediate coronary artery bypass grafting (CABG)
3. Emergency angiography and PCI of the IRA
4. Non-emergency angiography within 2 hours
5. No further intervention is possible due to bleeding risk

31. Question

A 55-year-old male presents to the emergency department with severe chest pain that started three hours ago. His ECG shows ST-segment elevation, and he receives fibrinolytic therapy. The treatment is successful, with significant resolution of symptoms and ECG changes. He remains hemodynamically stable.

What is the recommended timing for angiography and potential PCI of the infarct-related artery (IRA) in this patient?

1. Within 2 hours
2. Within 2 to 24 hours
3. Within 12 hours
4. Within 12 to 24 hours
5. Within 72 hours

32. Question

A 68-year-old female with a history of hypertension presents to the emergency department with chest pain that started four hours ago. Her ECG shows nonspecific ST-segment changes. She is diagnosed with non-ST-elevation acute coronary syndrome (NSTE-ACS).

What is the recommended management strategy during hospital admission for this patient?

1. An invasive strategy is not recommended
2. An invasive strategy is recommended if symptoms of ischemia persist after admission
3. An invasive strategy is recommended if high-risk criteria are present
4. An invasive strategy is recommended if high-risk criteria or if there is a high index of suspicion for unstable angina
5. An invasive strategy is recommended after initial imaging for myocardial ischemia (e.g myocardial SPECT or coronary CT angiography)

33. Question

In patients without very high- or high-risk NSTE-ACS criteria and with a low index of suspicion for NSTE-ACS, what approach is recommended?

1. Invasive approach is recommended
2. Conservative approach is recommended
3. Selective invasive approach
4. Non-invasive imaging only
5. Conservative approach is recommended if GRACE risk score <100

34. Question

According to clinical practice guidelines, in patients with a working diagnosis of NSTE-ACS, an immediate invasive strategy is recommended if they exhibit which of the following very high-risk criteria?

1. Mild chest pain that resolves with rest
2. Haemodynamic instability or cardiogenic shock
3. Stable heart rate and blood pressure
4. No changes in ST-segment or T wave
5. Absence of in-hospital life-threatening arrhythmias

35. Question

Under which condition should an early invasive strategy within 24 hours not be considered for patients with NSTE-ACS?

1. Confirmed diagnosis of unstable angina
2. Dynamic ST-segment or T wave changes
3. Transient ST-segment elevation
4. GRACE risk score >140
5. Confirmed diagnosis of NSTEMI

36. Question

What is the recommended initial oral loading dose (LD) of aspirin for patients without contraindications in acute coronary syndrome?

1. 50-150 mg
2. 150-300 mg
3. 300-450 mg
4. 75-250 mg
5. 75-100 mg

37. Question

In all ACS patients, what is recommended in addition to aspirin, given as an initial oral loading dose (LD) followed by a maintenance dose (MD) for 12 months unless there is high bleeding risk (HBR)?

1. A P2Y12 receptor inhibitor
2. A beta-blocker
3. A calcium channel blocker
4. An SGLT2 inhibitor
5. An angiotensin-converting enzyme inhibitor

38. Question

In patients at high risk of gastrointestinal bleeding, what is recommended in combination with dual antiplatelet therapy (DAPT)?

1. H2 receptor antagonist
2. Warfarin
3. Proton pump inhibitor
4. Calcium channel blocker
5. Measurement of HbA1c or fasting glucose

39. Question

What is the recommended dosing regimen of prasugrel in patients proceeding to PCI?

LD = loading dose. MD = maintenance dose.

1. 75 mg LD, 10 mg o.d. MD, 5 mg o.d. MD for patients aged 75 years or with a body weight <60 kg
2. 60 mg LD, 10 mg o.d. MD, 5 mg o.d. MD for patients aged 75 years or with a body weight <60 kg
3. 50 mg LD, 10 mg o.d. MD, 5 mg o.d. MD for patients aged 75 years or with a body weight <60 kg
4. 60 mg LD, 10 mg o.d. MD, 5 mg o.d. MD for all patients regardless of age or weight
5. 75 mg LD, 10 mg o.d. MD, 5 mg o.d. MD for patients aged 65 years or with a body weight <70 kg

40. Question

Which antiplatelet therapy is recommended irrespective of the treatment strategy (invasive or conservative) in patients with acute coronary syndrome, and at what dosages?

1. Clopidogrel
2. Prasugrel
3. Ticagrelor
4. Aspirin
5. Warfarin or NOAC

41. Question

In the context of antiplatelet therapy for acute coronary syndrome, when is clopidogrel recommended?

1. When prasugrel or ticagrelor are contraindicated
2. When prasugrel or ticagrelor are not available, cannot be tolerated, or are contraindicated
3. When patients have a history of gastrointestinal bleeding
4. When patients are undergoing coronary artery bypass graft surgery
5. When patients are managed conservatively

42. Question

In patients presenting with acute coronary syndrome (ACS) who stop dual antiplatelet therapy (DAPT) to undergo coronary artery bypass grafting (CABG), what is the recommended duration for resuming DAPT after surgery?

1. At least 6 months
2. At least 9 months
3. At least 12 months
4. At least 18 months
5. At least 24 months

43. Question

Which antiplatelet therapy should be considered in preference for ACS patients who proceed to PCI?

1. Bivalirudin
2. Clopidogrel
3. Prasugrel
4. Warfarin
5. Ticagrelor

44. Question

In the context of antiplatelet therapy in acute coronary syndrome, when should GP IIb/ IIIa receptor antagonists be considered?

1. When there is evidence of significant bleeding.
2. When there is evidence of no-reflow or a thrombotic complication during PCI.
3. When there is evidence of an unstable (vulnerable) plaque.
4. When there is evidence of low coronary perfusion pressure
5. When there is evidence of complete arterial occlusion

45. Question

In P2Y12 receptor inhibitor-nave patients undergoing PCI, which antiplatelet therapy may be considered?

1. Rivaroxaban
2. Edoxaban
3. Dabigatran
4. Cangrelor
5. Tirofiban

46. Question

In older ACS patients, especially those with high bleeding risk (HBR), which P2Y12 receptor inhibitor may be considered?

1. Fondaparinux
2. Apixaban
3. Clopidogrel
4. Bivalirudin
5. Warfarin

47. Question

In patients undergoing a primary PCI strategy, what is the role of pretreatment with P2Y12 inhibitors?

1. Pre-treatment is contraindicated prior to angiography (class III recommendation)
2. Pre-treatment is recommended prior to angiography (class I recommendation)
3. Pre-treatment may be considered (class IIb recommendation)
4. Pre-treatment should be considered (class IIa recommendation)
5. Pre-treatment is recommended in patients with previous myocardial infarction

48. Question

In the context of NSTE-ACS, when may pretreatment with a P2Y12 receptor inhibitor be considered?

1. In patients who are expected to undergo an early invasive strategy (<24 h) and have high bleeding risk (HBR).
2. In patients who are not expected to undergo an early invasive strategy (<24 h) and have high bleeding risk (HBR).
3. In patients who are expected to undergo an early invasive strategy (<24 h) and do not have high bleeding risk (HBR).
4. In patients who are not expected to undergo an early invasive strategy (<24 h) and do not have high bleeding risk (HBR).
5. In patients who are expected to undergo a late invasive strategy (>24 h) and have high bleeding risk (HBR).

49. Question

In the context of acute coronary syndrome, which of the following is NOT recommended as pretreatment?

1. Aspirin
2. Clopidogrel
3. GP IIb/IIIa receptor antagonist
4. Prasugrel
5. Ticagrelor

50. Question

In patients with NSTE-ACS where coronary anatomy is unknown and early invasive management (<24 hours) is planned, what is the guideline recommendation regarding routine pretreatment with a P2Y12 receptor inhibitor?

1. It is recommended.
2. It is recommended in high-risk patients.
3. It is not recommended.
4. It is recommended for most patients.
5. It is to be considered based on GRACE and TIMI Score

51. Question

In patients diagnosed with acute coronary syndrome (ACS), what is recommended regarding anticoagulation therapy?

1. Oral anticoagulation is recommended for all patients with ACS at the time of diagnosis.
2. Parenteral anticoagulation is recommended only for patients undergoing surgery.
3. Parenteral anticoagulation is recommended for all patients with ACS at the time of diagnosis.
4. Anticoagulation therapy is not recommended for patients with ACS.
5. Anticoagulation therapy should be deferred until after initial treatment for ACS.

52. Question

In patients undergoing PCI, what is the recommended routine use of a UFH bolus during the procedure?

1. A fixed i.v. bolus of 50 IU/kg
2. A weight-adjusted i.v. bolus during PCI of 70-100 IU/kg
3. A weight-adjusted i.v. bolus during PCI of 50-70 IU/kg
4. A fixed i.v. bolus of 100 IU/kg
5. An i.v. bolus adjusted to patient age and renal function

53. Question

In patients pretreated with subcutaneous enoxaparin, what is recommended at the time of PCI?

1. Intravenous unfractionated heparin
2. Intravenous bivalirudin
3. Discontinuation of anticoagulants
4. Intravenous enoxaparin
5. No additional anticoagulant therapy

54. Question

When should discontinuation of parenteral anticoagulation be considered in patients undergoing an invasive procedure?

1. Before the invasive procedure
2. During the invasive procedure
3. Immediately after the invasive procedure
4. One day after the invasive procedure
5. One week after the invasive procedure

55. Question

Which anticoagulant should be considered as an alternative to UFH in patients with STEMI undergoing PPCI?

1. Warfarin
2. Dabigatran
3. Rivaroxaban
4. Enoxaparin
5. Apixaban

56. Question

In patients with STEMI undergoing PPCI, what alternative to UFH should be considered with a full-dose post-PCI infusion?

1. TXA2
2. Fibrin
3. Warfarin
4. Bivalirudin
5. Dabigatran

57. Question

Which anticoagulant is not recommended in patients with STEMI undergoing PPCI?

1. Aspirin
2. Clopidogrel
3. UFH
4. Fondaparinux
5. Enoxaparin

58. Question

For patients with NSTE-ACS in whom early invasive angiography (i.e., within 24 h) is not anticipated, which anticoagulant is recommended?

1. Heparin
2. Warfarin
3. Enoxaparin
4. Fondaparinux
5. Dabigatran

59. Question

For patients with NSTE-ACS in whom early invasive angiography (i.e. within 24 h) is anticipated, which antithrombotic agent should be considered as an alternative to UFH?

1. Clopidogrel
2. Warfarin
3. Enoxaparin
4. Aspirin
5. Dabigatran

60. Question

In patients with atrial fibrillation with an indication for oral anticoagulation, what is the recommended strategy for antithrombotic therapy after 1 week of triple antithrombotic therapy (TAT) following an acute coronary syndrome (ACS) event?

TAT = triple antithrombotic therapy.

DAT = dual antithrombotic therapy.

1. Continue TAT for 12 months.
2. Switch to DAT using a NOAC and clopidogrel for up to 12 months.
3. Use only clopidogrel for 12 months.
4. Use only a NOAC for 12 months.
5. Switch to DAPT using aspirin and clopidogrel for up to 12 months.

61. Question

A 70-year-old male with atrial fibrillation presents with acute coronary syndrome and is scheduled for percutaneous coronary intervention (PCI). He is currently taking a non-vitamin K antagonist oral anticoagulant (NOAC).

What is the recommended anticoagulation management strategy during PCI for this patient?

1. Intravenous aspirin
2. Switch NOAC to warfarin
3. UFH bolus
4. UFH bolus if INR < 3
5. UFH bolus if INR < 3.5

62. Question

In patients with an indication for OAC with VKA in combination with aspirin and/or clopidogrel, what is the recommended target INR and time in the therapeutic range?

1. Target INR of 1.5-2.0 with a time in the therapeutic range >60%
2. Target INR of 2.0-2.5 with a time in the therapeutic range >70%
3. Target INR of 2.5-3.0 with a time in the therapeutic range >75%
4. Target INR of 3.0-3.5 with a time in the therapeutic range >65%
5. Target INR of 1.0-1.5 with a time in the therapeutic range >50%

63. Question

When combining antiplatelets and OAC, which dosage of rivaroxaban should be considered when concerns about high bleeding risk (HBR) prevail over ischemic stroke?

1. Rivaroxaban 10 mg o.d.
2. Rivaroxaban 15 mg o.d.
3. Rivaroxaban 20 mg o.d.
4. Rivaroxaban 25 mg o.d.
5. Rivaroxaban 30 mg o.d.

64. Question

In patients at high bleeding risk (HBR) undergoing combination therapy with antiplatelets and oral anticoagulants (OAC), which dosing regimen of dabigatran should be considered to mitigate bleeding risk?

1. Dabigatran 75 mg b.i.d.
2. Dabigatran 110 mg b.i.d.
3. Dabigatran 150 mg b.i.d.
4. Dabigatran 220 mg once daily
5. Dabigatran 300 mg once daily

65. Question

In patients requiring anticoagulation and treated medically, how long should a single antiplatelet agent in addition to an OAC be considered?

1. 3 months
2. 6 months
3. 9 months
4. Up to 12 months
5. Indefinitely

66. Question

In patients treated with an OAC, for how long should aspirin plus clopidogrel be considered in those with high ischaemic risk or with other anatomical/procedural characteristics that are judged to outweigh the bleeding risk?

1. Longer than 1 week and up to 1 month
2. Up to 1 week
3. Up to 3 months
4. Longer than 3 months
5. Indefinitely

67. Question

In patients requiring OAC, when can antiplatelet therapy be withdrawn while continuing OAC?

1. It may be considered at 3 months
2. It may be considered at 6 months
3. It may be considered at 9 months
4. It may be considered at 12 months
5. It may be considered at 18 months

68. Question

In the context of triple antithrombotic therapy (TAT) for acute coronary syndrome, which of the following is NOT recommended?

1. The use of aspirin in combination with an oral anticoagulant
2. The use of ticagrelor or prasugrel as part of triple antithrombotic therapy
3. The use of clopidogrel in combination with an oral anticoagulant
4. The use of rivaroxaban in combination with an antiplatelet agent
5. The use of dual antiplatelet therapy without an oral anticoagulant

69. Question

In patients who are event-free after 3-6 months of DAPT and who are not at high ischaemic risk, what change in antithrombotic therapy may be considered?

1. Stop DAPT
2. Start monotherapy with aspirin
3. Start monotherapy with a P2Y12 receptor inhibitor
4. Continue with TAT
5. Discontinue all antithrombotic therapy

70. Question

What alternative DAPT strategy may be considered to reduce bleeding risk according to the recommendation for de-escalation of P2Y12 receptor inhibitor treatment?

1. Switching from clopidogrel to prasugrel
2. Switching from ticagrelor to prasugrel
3. Switching from clopidogrel to ticagrelor
4. Switching from prasugrel/ticagrelor to clopidogrel
5. Switching from prasugrel to ticagrelor

71. Question

In HBR patients, what antithrombotic therapy regimen may be considered after 1 month of DAPT?

HBR = high bleeding risk.

1. Dual antiplatelet therapy (DAPT) for another 12 months
2. Aspirin or P2Y12 inhibitor monotherapy (P2Y12 inhibitor preferred)
3. Triple antithrombotic therapy (TAT)
4. Aspirin or P2Y12 inhibitor monotherapy (aspirin preferred)
5. Switching to OAC monotherapy

72. Question

In the first 30 days after an ACS event, what is the recommendation regarding the de-escalation of antiplatelet therapy?

1. It is strongly recommended.
2. It is recommended.
3. It is not recommended.
4. It is recommended in patients at low ischemic risk.
5. It is recommended in patients at high ischemic risk.

73. Question

After an acute coronary syndrome, when is it recommended to discontinue antiplatelet treatment in patients treated with an oral anticoagulant (OAC)?

1. After 3 months
2. After 6 months
3. After 9 months
4. After 12 months
5. After 18 months

74. Question

When should a second antithrombotic agent be added to aspirin for extended long-term secondary prevention?

1. In patients with low ischaemic risk and with high bleeding risk (HBR)
2. Only in patients with high bleeding risk (HBR)
3. In patients with high ischaemic risk and without high bleeding risk (HBR)
4. In all patients regardless of risk factors
5. Only in the first month after an ischemic event

75. Question

For extended long-term secondary prevention, in which group of patients may adding a second antithrombotic agent to aspirin be considered?

1. Patients with moderate ischaemic risk and high bleeding risk
2. Patients with low ischaemic risk and without high bleeding risk
3. Patients with high ischaemic risk and high bleeding risk
4. Patients with moderate ischaemic risk and without high bleeding risk*
5. Patients with low ischaemic risk and with high bleeding risk

76. Question

Which of the following regimens may be considered as an alternative to aspirin monotherapy for long-term antithrombotic therapy?

1. Warfarin monotherapy
2. Dual antiplatelet therapy (DAPT)
3. Triple antiplatelet therapy (TAT)
4. P2Y12 inhibitor monotherapy
5. Direct oral anticoagulant (DOAC) monotherapy

77. Question

When fibrinolysis is the reperfusion strategy, what is the recommended target time to initiate treatment after diagnosis in the pre-hospital setting?

1. <5 minutes
2. <10 minutes
3. <15 minutes
4. <20 minutes
5. <30 minutes

78. Question

Which of the following agents are recommended for fibrinolytic therapy?

1. Tenecteplase, alteplase, streptokinase
2. Tenecteplase, alteplase, urokinase
3. Tenecteplase, alteplase, reteplase
4. Tenecteplase, alteplase, saruplase
5. Tenecteplase, alteplase, metaplase

79. Question

Regarding fibrinolytic therapy using tenecteplase, what is recommended for patients over 75 years of age?

1. A full dose of tenecteplase should be considered.
2. A quarter dose of tenecteplase should be avoided.
3. A half-dose of tenecteplase should be considered.
4. Tenecteplase is contraindicated in patients 75 years or older
5. Tenecteplase is contraindicated in patients 75 years or older and reduced eGFR

80. Question

Which of the following is recommended as antiplatelet co-therapy with fibrinolysis?

1. Antiplatelets are contraindicated in patients treated with fibrinolysis
2. Aspirin and ticagrelor
3. Aspirin and prasugrel
4. Aspirin and clopidogrel
5. Aspirin and rivaroxaban

81. Question

In patients treated with fibrinolysis, for how long is anticoagulation recommended?

1. Until discharge
2. For 3 days, or until complete ST segment resolution
3. Until revascularization (if performed) or for the duration of hospital stay (up to 8 days)
4. For 2 days
5. Until ECG changes and symptoms have resolved

82. Question

Which anticoagulant is recommended as the preferred co-therapy with fibrinolysis?

1. Heparin i.v followed by s.c.
2. Warfarin p.o.
3. Enoxaparin i.v. followed by s.c.
4. Dabigatran
5. Bivalirudin or eptifibatide

83. Question

When enoxaparin is not available, which anticoagulant is recommended as a weight-adjusted i.v. bolus, followed by infusion for fibrinolytic therapy?

1. Eptifibatide
2. Tirofiban
3. Fondaparinux
4. Unfractionated Heparin (UFH)
5. Bivalirudin

84. Question

In patients treated with streptokinase, what anticoagulation co-therapy should be considered?

1. An i.v. bolus of heparin followed by an oral dose 24 h later
2. An i.v. bolus of heparin followed by an s.c. dose 24 h later
3. An i.v. bolus of UFH followed by an s.c. dose 24 h later
4. An i.v. bolus of fondaparinux followed by an s.c. dose 24 h later
5. An i.v. bolus of eptifibatide followed by an s.c. dose 24 h later

85. Question

A 58-year-old female is resuscitated following a cardiac arrest. Her ECG, after ROSC, shows persistent ST-segment elevations in leads V2-V5). She becomes hemodynamically unstable with low blood pressure despite repeated intravenous epinephrine. The emergency physician suggested fibrinolysis and continued mechanical CPR.

What is the recommended management strategy for this patient?

1. Fibrinolysis
2. Immediate defibrillation
3. Primary PCI
4. 1 mg epinephrine and immediate fibrinolysis
5. New ECG to confirm the presence of ST elevations

86. Question

In the case of resuscitated cardiac arrest, what is the recommendation for routine immediate angiography in hemodynamically stable patients without persistent ST-segment elevation (or equivalents)?

1. It is always recommended.
2. It is recommended only if the patient is symptomatic.
3. It is not recommended.
4. It is recommended if the patient’s history suggests previous heart issues.
5. It is recommended only if the patient is above a certain age.

87. Question

What is recommended for adults who remain unresponsive after return of spontaneous circulation following either out-of-hospital or in-hospital cardiac arrest?

1. Immediate transfer to a cardiac care unit
2. Temperature control and prevention of fever (>37.7C)
3. Administration of high-dose steroids
4. Initiation of mechanical ventilation
5. Routine use of anti-arrhythmic drugs

88. Question

When is the evaluation of neurological prognosis recommended in comatose survivors after cardiac arrest?

1. Within 24 hours after admission
2. Between 24 and 48 hours after admission
3. Between 48 and 72 hours after admission
4. No earlier than 72 hours after admission
5. It is not recommended to evaluate neurological prognosis in comatose survivors

89. Question

What is recommended for patients with cardiogenic shock (CS) complicating acute coronary syndrome (ACS)?

1. Immediate coronary angiography and PCI of the IRA (if indicated)
2. Delayed coronary angiography and PCI of the IRA (if indicated)
3. Immediate coronary angiography and PCI of the IRA (if indicated) and bystander lesions (if indicated)
4. Delayed coronary angiography and PCI of the IRA (if indicated) and bystander lesions (if indicated)
5. Delayed coronary angiography with optimization of inotropic and vasopressor agents.

90. Question

In the management of cardiogenic shock, what is recommended if percutaneous coronary intervention (PCI) of the infarct-related artery (IRA) is not feasible or unsuccessful?

1. Emergency CABG
2. Thrombolytic therapy.
3. Perform an immediate heart transplant.
4. Medical management only.
5. Mechanical circulatory support.

91. Question

In cases of hemodynamic instability, what is recommended for the repair of mechanical complications of Acute Coronary Syndrome (ACS)?

1. Immediate surgical intervention
2. Emergency surgical/catheter-based repair based on Heart Team discussion
3. Conservative medical management
4. Immediate catheter-based intervention
5. Conservative medical management if hemodynamically stable

92. Question

In patients with STEMI presenting with cardiogenic shock, under what condition should fibrinolysis be considered?

1. When PPCI strategy is not available within 130 minutes from the time of STEMI diagnosis
2. When PPCI strategy is not available within 120 minutes from the time of STEMI diagnosis
3. When PPCI strategy is not available within 110 minutes from the time of STEMI diagnosis and mechanical complications have been ruled out
4. When PPCI strategy is not available within 120 minutes from the time of STEMI diagnosis and mechanical complications have been ruled out
5. When mechanical complications have been ruled out regardless of PPCI availability

93. Question

In patients with ACS and severe/refractory cardiogenic shock, what intervention may be considered according to clinical practice guidelines?

1. ECMO
2. Heart transplantation
3. Short-term mechanical circulatory support
4. CRRT and ECMO
5. Long-term mechanical circulatory support

94. Question

In patients with acute coronary syndrome (ACS) and cardiogenic shock (CS) without mechanical complications, what is the recommendation regarding the routine use of an intra-aortic balloon pump (IABP)?

1. It is strongly recommended.
2. It is recommended.
3. It is not recommended.
4. It should be used as a second-line treatment.
5. It is recommended only if other treatments fail.

95. Question

What is recommended for STEMI patients and very high-risk NSTE-ACS patients regarding ECG monitoring?

1. ECG monitoring for a minimum of 48 hours
2. ECG monitoring for a minimum of 24 hours
3. ECG monitoring for a minimum of 72 hours
1. ECG monitoring for a minimum of 24 hours and asymptomatic
5. Daily blood tests for the first 48 hours

96. Question

For high-risk patients with successful reperfusion therapy and an uncomplicated clinical course, how long should they be kept in the CCU/ICCU before being moved to a step-down monitored bed?

1. A minimum of 12 hours
2. A minimum of 24 hours
3. A minimum of 36 hours
4. A minimum of 48 hours
5. A minimum of 72 hours

97. Question

Which of the following statements is true regarding the discharge of selected high-risk patients with ACS?

1. Discharge within 24-48 hours should be considered if early rehabilitation and adequate follow-up are arranged.
2. Discharge within 48-72 hours should be avoided.
3. Discharge of selected high-risk patients within 48-72 hours should be considered if early rehabilitation and adequate follow-up are arranged.
4. Discharge within 72 hours should be considered in all patients.
5. Discharge within 48-72 hours should be considered only if no follow-up is required.

98. Question

What is recommended for selected stable patients after successful and uneventful PCI?

1. Immediate discharge from the hospital
2. Same-day transfer should be considered
3. Overnight observation in the hospital
4. Weekly follow-up appointments
5. Prolonged hospital stay for monitoring

99. Question

Which patients should undergo routine echocardiography after an ACS?

1. All patients with ACS to assess regional and global LV function, detecting mechanical complications, and excluding LV thrombus.
2. Patients with STEMI or NSTEMI in order to assess regional and global LV function, detecting mechanical complications, and excluding LV thrombus.
3. All patients with elevated NT-pro-BNP, BNP or troponin
4. All patients with signs of left or right ventricular dysfunction
5. All patients prior to PCI

100. Question

When echocardiography is suboptimal or inconclusive, which imaging modality may be considered?

1. CT
2. PET
3. CMR
4. TEE
5. SPECT scan

101. Question

Which access route is recommended as the standard approach for PCI?

1. Femoral access
2. Jugular access
3. Brachial access
4. Radial access
5. Subclavian access

102. Question

In patients undergoing primary percutaneous coronary intervention (PPCI), what is recommended regarding the infarct-related artery (IRA) during the index procedure?

1. PCI with balloon angioplasty only
2. PCI with stent deployment in the IRA
3. Medical management without PCI
4. Delayed stent deployment in the IRA
5. PCI with rotational atherectomy

103. Question

Which type of stent is recommended in all cases according to the guidelines?

1. Bioabsorbable stents
2. Drug-eluting stents
3. DAPT compatible stents
4. Tacrolimus stents
5. Bare metal stents

104. Question

A 45-year-old woman presents to the emergency department with severe chest pain and immediate angiography reveals spontaneous coronary artery dissection (SCAD). When is PCI indicated in patients with SCAD?

1. Symptoms and signs of ongoing myocardial ischaemia, a large area of myocardium in jeopardy, and reduced antegrade flow.
2. In presence of multiple ST depressions
3. In presence of troponin elevations
4. In all cases
5. In cases with hemodynamic instability

105. Question

What is the role of intravascular imaging during primary PCI in acute coronary syndromes?

1. Intravascular imaging should be considered to guide PCI, even if there is a clear culprit lesion
2. Intravascular imaging should be considered to guide PCI, if there is no clear culprit lesion
3. Intravascular imaging should not be considered to guide PCI in acute coronary syndromes
4. Only OCT is suitable for imaging in acute coronary syndromes
4. Only IVUS is suitable for imaging in acute coronary syndromes

106. Question

In patients with ACS and an occluded IRA, what should be considered when primary PCI is not feasible or unsuccessful and there is a large area of myocardium in jeopardy?

1. Conservative management with high-intensity statin therapy and DAPT (dual antiplatelet therapy)
2. Thrombolysis
3. Drug eluting balloon (DEB)
4. Coronary artery bypass grafting (CABG)
5. Thrombus aspiration

107. Question

Which of the following statements is true regarding the use of thrombus aspiration during primary PCI?

1. Thrombus aspiration should be routinely used in all cases.
2. Thrombus aspiration is not recommended.
3. The routine use of thrombus aspiration is not recommended.
4. Thrombus aspiration is recommended if no-reflow occurs.
5. Thrombus aspiration is recommended in cases with complete occlusions.

108. Question

What is recommended for ACS patients presenting in cardiogenic shock with multivessel disease during the index procedure?

1. Complete revascularization (PCI of all significant lesions and occlusions)
2. Conservative medical management
3. PCI of the IRA only
4. CABG
5. PCI of the IRA and all significant lesions

109. Question

What is the recommended timeframe for complete revascularization in hemodynamically stable STEMI patients undergoing PPCI?

1. Within 48 hours
2. During the index PCI procedure or within 45 days
3. Within 72 days
4. 2. During the index PCI procedure or within 7 days
5. Only during the index PCI procedure

110. Question

How is non-infarct-related artery (non-IRA) stenosis severity evaluated in patients with STEMI?

1. Based on instantaneous wave-free ratio (iFR)
1. Based on fractional flow reserve (FFR)
3. Based on angiographic severity
4. Based on instantaneous wave-free ratio (iFR) and fractional flow reserve (FFR)
5. Based on IVUS or OCT

111. Question

In patients presenting with NSTE-ACS and multivessel disease (MVD), what is the recommended approach regarding revascularization?

1. Complete revascularization is always performed during the index procedure.
2. Complete revascularization is not performed during the index procedure.
3. Complete revascularization should be considered in all patients, preferably during the index procedure.
4. IRA-only PCI is recommended.
5. Complete revascularization should be considered in patients with hemodynamic instability

112. Question

How is non-infarct-related artery (non-IRA) stenosis severity evaluated in patients with NSTE-ACS?

1. Functional invasive evaluation during the index procedure may be considered
2. Angiographic evaluation during the index procedure may be considered
3. Non-invasive imaging (preferably SPECT) should precede non-IRA PCI.
4. Non-IRA PCI is based on the presence of elevated troponin levels.
5. Non-IRA PCI is based on correlation with ECG changes

113. Question

Which imaging modality is recommended for patients presenting with MINOCA (myocardial infarction with non-obstructive coronary arteries) following invasive angiography, if the diagnosis is not clear?

1. CT coronary angiography
2. Echocardiography
3. Echocardiography and CT coronary angiography
4. Cardiac MRI
5. Nuclear stress test

114. Question

When should an intra-aortic balloon pump (IABP) be considered in patients with acute coronary syndrome (ACS)?

1. IABP is no longer recommended due to lack of efficacy in randomized trials
2. In patients with haemodynamic instability/cardiogenic shock
3. In patients with haemodynamic instability/cardiogenic shock due to ACS-related mechanical complications
4. In patients with mechanical complications
5. In patients with hypotension

115. Question

A 60-year-old male presents to the emergency department with an acute anterior myocardial infarction. Echocardiography reveals a reduced ejection fraction (approximately 30%) with anterior hypokinesia/akinesia. During hospitalization, the patient experienced several embolic events, including a stroke, which led to the suspicion of a left ventricular (LV) thrombus.

What imaging modality should be considered to confirm or rule out the presence of an LV thrombus?

1. CT
2. Cardiac MRI
3. Repeated echocardiography
4. Transesophageal echocardiography
5. PET

116. Question

For how long should oral anticoagulant therapy (VKA or NOAC) be considered in patients with confirmed left ventricular thrombus?

1. 1-2 months
2. 3-6 months
3. 6-9 months
4. 9-12 months
5. Indefinitely

117. Question

A 62-year-old male presents to the hospital with an acute anterior myocardial infarction. During his evaluation, a standard echocardiogram is performed, but the apex of the left ventricle is not well visualized.

What imaging strategy may be considered in this patient to detect a LV thrombus?

1. Contrast CT
2. CT
3. Radionuclide imaging
4. Contrast echocardiogram
5. PET scan

118. Question

In patients with atrial fibrillation as a complication of acute coronary syndrome, when is the use of intravenous beta-blockers recommended for rate control?

1. In all patients
2. In the presence of hemodynamic instability caused by atrial fibrillation
3. In the absence of acute heart failure or hypotension
4. When oral beta-blockers are ineffective
5. When calcium channel blockers are ineffective or contraindicated

119. Question

A 65-year-old female with a history of coronary artery disease presents to the emergency department with an acute coronary syndrome. She has developed rapid atrial fibrillation and signs of acute heart failure (HF), but her blood pressure remains stable at 115/70 mmHg.

What is the recommended medication for rate control in this patient?

1. Verapamil
2. Diltiazem
3. Metoprolol
4. Bisoprolol
5. Intravenous amiodarone

120. Question

In patients with acute coronary syndrome (ACS) and haemodynamic instability due to atrial fibrillation, what is recommended when adequate rate control cannot be achieved promptly with pharmacological agents?

1. Immediate electrical cardioversion
2. Intravenous labetalol
3. Intravenous digoxin
4. Intravenous amiodarone
5. Intravenous metoprolol

121. Question

In unstable patients with recent-onset atrial fibrillation (AF), which medication is recommended to facilitate electrical cardioversion and/or decrease the risk for early recurrence of AF after electrical cardioversion?

1. Intravenous diltiazem or verapmail
2. Oral metoprolol
3. Intravenous amiodarone
4. Oral digoxin
5. Any class III antiarrhythmic agent

122. Question

In patients with de novo atrial fibrillation (AF) during the acute phase of acute coronary syndrome (ACS), how is long-term management of anticoagulation and antiplatelet therapy determined?

1. Long-term oral anticoagulation with Vitamin K antagonists (VKA) is generally recommended
2. Long-term oral anticoagulation (NOAC as the preferred drug) depending on the CHA2DS2-VASc score, after considering the HAS-BLED score and concomitant antiplatelet therapy
3. Long-term oral anticoagulation depending on the CHA2DS2-VASc score.
4. Anticoagulation is postponed until completion of dual antiplatelet therapy (12 months)
5. Anticoagulation is not required in patients managed with dual antiplatelet therapy

123. Question

A 68-year-old male with a history of myocardial infarction (MI) 5 months ago and symptomatic heart failure (NYHA Class II) is being evaluated in the outpatient clinic. His left ventricular ejection fraction (LVEF) is 30%, despite being on optimal medical therapy for the past four months. He is otherwise in good functional status.

What therapy is recommended to reduce the risk of sudden cardiac death in this patient?

1. Amiodarone and/or beta-blocker
2. Conduct electrophysiological testing before proceeding to implantation of ICD (implantable cardioverter-defibrillator)
3. Implant an ICD (implantable cardioverter-defibrillator)
4. Assess residual myocardial ischemia with SPECT or other non-invasive imaging
4. Assess residual myocardial ischemia with coronary angiography, including functional assessment (FFR, iFR)

124. Question

A 65-year-old female with a history of hypertension presents to the emergency department with acute coronary syndrome. Due to ongoing gastrointestinal bleeding, it is determined to postpone angiography and PCI (which requires anticoagulation and antiplatelet drugs). She develops polymorphic ventricular tachycardia (VT) which degenerates into ventricular fibrillation (VF). Resuscitation, with 3 defibrillations, is successful.

What is the recommended treatment for managing the ventricular arrhythmias in this patient, assuming there are no contraindications?

1. Oral beta-blocker
2. Intravenous beta-blocker and/or amiodarone
3. Oral calcium channel blocker
4. Oral amiodarone
5. Intravenous magnesium sulfate

125. Question

A 62-year-old male is admitted to the coronary care unit due to unstable angina. He experiences recurrent episodes of ventricular tachycardia (VT). Troponin levels are not elevated and he is asymptomatic, except from recurrent VT.

What is the recommended strategy to treat the underlying myocardial ischaemia in this patient with recurrent VT and/or VF?

1. Administration of beta-blockers
2. Administration of amiodarone
3. Administration of beta-blockers and amiodarone
4. Prompt and complete revascularization
5. No intervention is required for recurrent VT without hemodynamic effects

126. Question

In the context of acute coronary syndrome complications, what should be considered if ventricular tachycardia (VT) cannot be controlled by revascularization, pharmacological agents and repeated electrical cardioversion?

1. CABG
2. Class III antiarrhythmic drugs
3. Transvenous catheter pacing termination and/or overdrive pacing
4. Surgical intervention
5. Continuous infusion of intravenous beta-blockers

127. Question

In patients with acute coronary syndromes and recurrent VT, VF, or electrical storm despite complete revascularization and optimal medical therapy, what should be considered?

1. Amiodarone
2. Non-invasive imaging to assess residual ischemia
3. Invasive functional assessment of residual ischemia
4. Radiofrequency catheter ablation at a specialized ablation centre followed by ICD implantation
5. Conservative management

128. Question

When treating recurrent ventricular tachycardia (VT) with hemodynamic effects, which medication may be considered if beta-blockers, amiodarone, and overdrive stimulation are not effective or applicable?

1. Diltiazem
2. Sotalol infusion
3. Lidocaine
4. Verapamil
5. Digoxin

129. Question

What may be considered for patients with recurrent life-threatening ventricular arrhythmias to reduce sympathetic drive?

1. Beta-blockers
2. Amiodarone
3. Sedation or general anaesthesia
4. Sotalol
5. Calcium channel blockers

130. Question

In which patients may ICD implantation or the temporary use of a wearable cardioverter defibrillator be considered within 40 days after MI?

1. In patients who experienced sudden cardiac arrest prior to hospitalization
2. In patients who experienced sudden cardiac arrest prior to revascularization
3. Patients who developed ventricular arrhythmias more than 48 hours after STEMI onset
4. Patients with left ventricular ejection fraction <25%
5. Patients with left ventricular ejection fraction <35%

131. Question

Which of the following is recommended for the treatment of asymptomatic and haemodynamically irrelevant ventricular arrhythmias in patients with acute coronary syndromes?

1. Class I antiarrhythmics
2. Class 2 antiarrhythmics
3. Class 3 antiarrhythmics
4. Beta-blockers
5. Anti-arrhythmic drugs are not recommended

132. Question

A patient with NSTEMI undergoes successful PCI, but subsequently develops sinus bradycardia with hemodynamic intolerance, and episodes of high-degree AV block without stable escape rhythm.

Which of the following treatments is recommended?

1. Initial treatment is oral beta-blockers
2. Initial treatment is i.v. positive chronotropic medication (atropine, adrenaline, vasopressin)
3. Initial treatment is permanent pacing
4. Initial treatment is temporary pacing
5. No treatment required the first 5 days

133. Question

If a patient with NSTEMI develops hemodynamically significant sinus bradycardia, or high-degree AV block without stable escape rhythm, what is the recommended urgent intervention if the patient has not received previous reperfusion therapy?

1. Permanent pacemaker
2. Thrombolysis
3. Urgent angiography with a view to revascularization
4. i.v. Atropine, vasopressin or adrenalin
5. Conservative management

134. Question

When is the implantation of a permanent pacemaker recommended in patients with acute coronary syndrome complicated by high-degree AV-block?

1. Immediately after high-degree AV block is detected
2. If high-degree AV block does not resolve within a waiting period of at least 5 days after MI
3. If the patient experiences recurrent syncope
4. If high-degree AV block persists for more than 24 hours after MI
5. If high-degree AV block does not resolve within a waiting period of at least 7 days after MI

135. Question

In patients with a high-degree AV block in the context of an anterior wall MI and acute heart failure, what treatment may be considered?

1. It is not recommended
2. In patients with left ventricular ejection fraction <35%
3. In patients with QRS duration >150 ms
4. In patients with high-degree AV block in the context of an anterior wall MI.
5. In patients with high-degree AV block in the context of an anterior wall MI and acute HF.

136. Question

Under which condition is pacing NOT recommended for patients experiencing high-degree AV block?

1. When high-degree AV block resolves after revascularization or spontaneously.
2. When high-degree AV block resolves within 7 days
3. When high-degree AV block is accompanied by hypotension.
4. When high-degree AV block is accompanied by adequate escape rhythm
5. When high-degree AV block is responsive to pharmacological therapy.

137. Question

In patients with chronic kidney disease undergoing invasive strategies for acute coronary syndrome, what is recommended regarding the use of contrast media?

1. Use high-osmolar contrast media
2. Avoid the use of contrast media.
3. Use low- or iso-osmolar contrast media at the lowest possible volume.
4. Use iso-osmolar contrast media
5. Use low-osmolar contrast media with rapid infusion rate

138. Question

In patients with acute coronary syndrome (ACS), what is the recommended method for assessing kidney function?

1. Serum creatinine
2. Plasma creatinine
3. Iohexol clearance
4. eGFR (estimated Glomerular Filtration Rate) assessment
5. LVEF

139. Question

In patients with chronic kidney disease (CKD) who present with acute coronary syndrome, which of the following is recommended regarding diagnostic and therapeutic strategies?

1. Avoid antiarrhythmic drugs
2. Avoid high-dose statin therapy
3. Apply the same diagnostic and therapeutic strategies as in patients with normal kidney function, with dose adjustment if necessary.
4. Initiate SGLT2 inhibitors in all patients with reduced eGFR
5. Inititiate finerenone in all patients with diabetes and reduced eGFR

140. Question

In patients at risk of contrast-induced nephropathy, especially those with acute kidney injury and/or CKD with eGFR <30 mL/min/1.73m, what should be considered during and after angiography?

1. Loop diuretics
2. Metolazone
3. Hydration
4. Corticosteroids and hydration
5. ACE inhibitors or SGLT2 inhibitors.

141. Question

In which patients with acute coronary syndrome should glycemic status be evaluated?

1. All patients with a history of diabetes
2. All patients
3. Patients with elevated troponin levels
4. Patients with features of the metabolic syndrome
5. Patients who are overweight or obese

142. Question

In patients with acute coronary syndrome (ACS) and persistent and significant hyperglycaemia, what treatment should be commenced?

1. Glucose-lowering therapy according to guidelines
2. Initiation of insulin therapy during hospital admission and oral therapies after discharge
3. SGLT2 inhibitors are initiated during hospital stay. Other treatments are initiated after discharge.
4. Metformin is initiated during hospital stay. Other treatments are initiated after discharge.
5. Hyperglycemia is generally due to stress caused by ACS; treatment of hyperglycemia is not indicated.

143. Question

What is the recommended approach to diagnostic and treatment strategies in older patients compared to younger patients with ACS?

1. Use more conservative diagnostic and treatment strategies in older patients.
2. Avoid invasive procedures in patients older than 80 years
3. Apply the same diagnostic and treatment strategies in older patients as in younger patients.
4. Avoid invasive procedures in patients older than 75 years
5. DAPT and anticoagulants are avoided if possible

144. Question

In cancer patients presenting with high-risk acute coronary syndrome (ACS), what is the recommended strategy concerning PCI?

1. PCI is discouraged in patients with cancer
2. PCI is discouraged in patients with metastasized cancer
3. PCI is recommended in all patients
4. PCI is recommended in all patients with >6 months expected survival from cancer
5. No recommendations have been issued

145. Question

In patients with cancer who are suspected to have cancer therapy contributing to acute coronary syndrome (ACS), what is the recommended?

1. Continue cancer therapy
2. Use DAPT irrespective of PCI
3. Lower the dosage of the current cancer medications
4. Switch to a different cancer therapy
5. Temporarily interrupt cancer therapy

146. Question

At what platelet count is aspirin not recommended in patients with cancer?

1. <10 000/ L
2. <5000/ L
3. Aspirin is recommended in all patients
4. <20 000/ L
5. <30 000/ L

147. Question

At what platelet count is clopidogrel not recommended in patients with ACS?

<10 000/ L
<20 000/ L
<30 000/ L
<40 000/ L
<50 000/ L

148. Question

At what platelet count are prasugrel and ticagrelor not recommended in patients with ACS?

<10 000/ L
<20 000/ L
<30 000/ L
<40 000/ L
<50 000/ L

149. Question

What is recommended for all ACS patients regarding cardiac rehabilitation?

1. Exercise should be avoided during the first 90 days after ACS
2. A medically supervised, structured, multidisciplinary, exercise-based rehabilitation and programme is recommended.
3. They should engage in light physical activities.
4. They should participate in a diet-focused cardiac rehabilitation programmes.
5. Cardiac rehabilitation is optional and can be decided based on the patient’s personal preference.

150. Question

Which of the following lifestyle changes is recommended for ACS patients for long-term management?

1. Healthy diet, alcohol restriction, regular aerobic physical activity and resistance exercise, reduced sedentary time
2. Adopting a Mediterranean-style diet
3. Stopping smoking, alcohol restriction, regular aerobic physical activity and resistance exercise, reduced sedentary time
4. Stopping smoking
5. Stopping smoking, healthy diet (Mediterranean style), alcohol restriction, regular aerobic physical activity and resistance exercise, reduced sedentary time

151. Question

In smokers, which of the following should be considered for long-term management support?

1. Nicotine replacement therapy (NRT)
2. Varenicline or bupropion
3. Follow-up support, NRT, varenicline or bupropion, individually or in combination
4. Follow-up support at a certified centre
5. None of the above are evidence-based

152. Question

What is recommended regarding high-dose statin therapy after ACS?

1. High-dose statin therapy is indicated if initial LDL-C values are above 1.8 mmol/L (70 mg/dL)
2. High-dose statin therapy is indicated if initial LDL-C values are above 1.0 mmol/L (40 mg/dL)
3. High-dose statin therapy is indicated if initial LDL-C values are above 2.6 mmol/L (100 mg/dL)
4. High-dose statin therapy is indicated in all patients, regardless of LDL-C values
5. It is recommended to use high-dose statin therapy only after lifestyle modifications have failed.

153. Question

What is the recommended LDL-C level to aim for in long-term pharmacological treatment?

1. <1.4 mmol/L (<55 mg/dL) and a reduction by 30% from baseline
2. <1.8 mmol/L (<70 mg/dL) and a reduction by 40% from baseline
3. <2.0 mmol/L (<80 mg/dL) and a reduction by 45% from baseline
4. <1.4 mmol/L (<55 mg/dL) and a reduction by 50% from baseline
5. <1.0 mmol/L (<40 mg/dL) and a reduction by 60% from baseline

154. Question

If the LDL-C goal is not achieved despite maximally tolerated statin therapy after 4-6 weeks, what is the recommended next step?

1. Intensify lifestyle modifications
2. Switch to a different high-dose statin
3. Add ezetimibe
4. Add GLP-1 receptor (semaglutide, tirzepatide, etc.) agonist
5. Add PCSK9 inhibitor

155. Question

If the LDL-C goal is not achieved despite maximally tolerated statin therapy and ezetimibe after 4-6 weeks, what is recommended?

1. Increasing the dose of ezetimibe
2. Switching to a different high-dose statin
3. Evaluate for familial hypercholesterolemia
4. Initiating fibrate therapy
5. Adding a PCSK9 inhibitor

156. Question

A 70-year-old female with a history of hyperlipidemia and statin (rosuvastatin 20 mg) use presents to the hospital with an acute coronary syndrome (ACS).

What is the recommended approach to lipid-lowering therapy for this patient during her hospitalization?

1. Add PCSK9 inhibitor
2. Maintain current lipid-lowering therapy
3. Add ezetimibe
4. intensify lipid-lowering therapy
5. Switch statin to exetimibe and PCSK9 inhibitor

157. Question

For patients with a recurrent atherothrombotic event within 2 years of the first ACS episode while taking maximally tolerated statin-based therapy, what LDL-C goal may be considered?

1. <2.0 mmol/L (<80 mg/dL)
2. <1.5 mmol/L (<60 mg/dL)
3. <1.0 mmol/L (<40 mg/dL)
4. <0.5 mmol/L (<20 mg/dL)
5. <2.5 mmol/L (<100 mg/dL)

158. Question

A 65-year-old male presents to the hospital with an acute coronary syndrome (ACS). His LDL levels are very high (6 mmol/L [230 mg/dL]) despite being on a moderate-dose statin.

What combination therapy may be considered during his index hospitalization to manage his LDL levels?

1. High-dose statin
2. PCSK9 inhibitor
3. Combination therapy with high-dose statin plus ezetimibe
4. Combination therapy with high-dose statin, ezetimibe and PCSK9 inhibitor
5. Same recommendation as for other patients with ACS

159. Question

In which patients are beta-blockers recommended regardless of heart failure symptoms?

1. ACS patients with LVEF >50%
2. ACS patients with LVEF between 40-50%
3. ACS patients with LVEF <40%
4. ACS patients without any LVEF assessment
5. ACS patients with normal LVEF

160. Question

Which of the following is a recommendation for the routine use of beta-blockers in patients with ACS?

1. Routine use of beta-blockers for all ACS patients is recommended (class I) regardless of LVEF
2. Routine use of beta-blockers for all ACS patients should be considered (class IIa) regardless of LVEF
3. Routine use of beta-blockers for all ACS patients may be considered (class IIb) regardless of LVEF
4. Routine use of beta-blockers is not recommended (class III) regardless of LVEF
5. No recommendation exists.

161. Question

In patients with Acute Coronary Syndrome (ACS), which of the following conditions would warrant the recommendation of Angiotensin-converting enzyme (ACE) inhibitors for long-term management?

1. Patients with HF symptoms
2. Patients with HF symptoms, LVEF <40%
3. Patients with HF symptoms, LVEF <40%, diabetes
4. Patients with HF symptoms, LVEF <40%, diabetes, hypertension
5. Patients with HF symptoms, LVEF <40%, diabetes, hypertension, and/or CKD

162. Question

In the long-term management of ACS patients, when is treatment with mineralocorticoid receptor antagonists (MRA) indicated?

1. MRA is not indicated
2. LVEF <40% and HF or diabetes
3. LVEF <40%
4. Diabetes
5. LVEF <35

163. Question

What is the recommendation for routine ACE inhibitors in patients with ACS?

1. Routine ACE inhibitors should be avoided.
2. Routine ACE inhibitors should be considered.
3. Routine ACE inhibitors may be considered
4. No recommendation has been issued
5. No randomized trials have been conducted

164. Question

Which of the following is recommended to improve adherence and outcomes in secondary prevention after acute coronary syndrome (ACS)?

1. Telemedicine monitoring
2. No intervention is evidence-based
3. A polypill
4. Monthly outpatient visits
5. Annual outpatient visits

165. Question

In patients with pre-discharge LVEF <40%, when is it recommended to repeat the evaluation of LVEF to assess the potential need for primary prevention ICD implantation?

1. 2-4 weeks after an ACS
2. 4-6 weeks after an ACS
3. 6-12 weeks after an ACS
4. 12-16 weeks after an ACS
5. 16-20 weeks after an ACS

166. Question

Which imaging modality should be considered as an adjunctive tool to assess the potential need for primary prevention ICD implantation?

1. Echocardiography
2. Nuclear imaging
3. Cardiac magnetic resonance
4. Computed tomography (CT)
5. Positron emission tomography (PET)

167. Question

What is recommended for all ACS patients in terms of vaccination?

1. Hepatitis B vaccination
2. Tetanus vaccination
3. Influenza vaccination
4. Meningococcal vaccination
5. Pneumococcal vaccination

168. Question

When may low-dose colchicine (0.5 mg once daily) be considered?

1. When all risk factors are sufficiently controlled.
2. If recurrent cardiovascular disease events occur despite optimal therapy.
3. As the first line of treatment for all patients.
4. Only in patients without any other risk factors.
5. As a substitute for optimal therapy.

169. Question

In the context of acute coronary syndrome care, which of the following is recommended for assessing mental well-being?

1. Routine physical examinations
2. Use of a validated tool for mental well-being assessment and onward psychological referral when appropriate
3. Regular cardiovascular stress testing
4. Comprehensive metabolic panel screenings
5. Genetic testing for predisposition to coronary artery disease

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