Question	True	False
1. Typical anginal chest pain is classically described as left-sided chest pain that is worse on inspiration or chest wall movements and relieved by analgesia.
2. In patients with known history of anginal chest pain, the presence of unstable angina may be characterised by chest pain of increasing frequency, duration and severity, or pain that occurs at rest or does not improve with glyceryl trinitrate (GTN) use.
3. Acute coronary syndrome (ACS) is a specific form of ischaemic heart disease that comprises only non-ST segment elevation myocardial infarction (NSTEMI) and ST segment elevation myocardial infarction (STEMI).
4. Hypertroponinaemia may be present in both myocardial injury and myocardial infarction (MI).
5. The presence of elevated troponins in a patient with end-stage renal failure is always suggestive of an acute cardiac event such as acute MI or acute myocardial injury.
6. Approximately 30% of undifferentiated patients who present to the emergency department with acute chest pain (ACP) are found to have ACS.
7. Atypical presentations of MI are more commonly observed in females and elderly patients as compared to males and younger patients.
8. It is not relevant to measure systolic blood pressure differentials of the two limbs when examining a patient with sudden-onset tearing chest pain that radiates to the back.
9. Commonly performed initial investigations in a patient with ACP include electrocardiogram (ECG), cardiac biomarkers and imaging modalities like chest radiograph.
10. The presence of a single, elevated troponin value >99th percentile of the upper reference limit is sufficient to diagnose NSTEMI.
11. Wellen’s syndrome refers to specific ECG changes that are suggestive of significant right coronary artery stenosis.
12. The presence of a new-onset left bundle brunch block on ECG is always equivalent to a STEMI and warrants immediate ‘cath lab activation’ for revascularisation therapy.
13. In a patient with ACP, assessing the pretest probability of coronary artery disease can be useful to guide subsequent cardiac diagnostic work up.
14. Cardiac stress testing, such as stress myocardial perfusion imaging, should always be performed in a patient with newly diagnosed MI.
15. In rare instances, laboratory assay interference may lead to falsely elevated troponin levels.
16. In the acute inpatient setting, common clinical precipitants of type 2 MI (T2MI) include anaemia, sepsis, renal impairment, cardiac arrhythmias and postoperative state.
17. The presence of heterophile antibodies in the patient’s serum may cause troponin assay interference, leading to false-positive results.
18. Management of STEMI involves emergency percutaneous coronary revascularisation and initiation of guideline-directed medical therapy including dual antiplatelet therapy (DAPT), heparin, beta-blocker, angiotension-converting enzyme inhibitors/angiotensin receptor blockers and statin.
19. The target ‘door-to-balloon’ time for STEMI is 120 min.
20. Treatment of T2MI involves prompt initiation of DAPT (loading and maintenance dose), that usually comprises aspirin with either clopidogrel, ticagrelor or prasugrel.