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acute & critical care cc > 1. ACS > Flashcards

1. ACS Flashcards

1
Q

PP

A

Most commonly due to underlying CVD

Atherosclerosis of coronary arteries that supply heart

Thrombus breaks off and occludes a coronary artery causing ischaemia

Rarely due to other causes such as acute coronary vasospasm

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2
Q

What does the RCA supply?

A

RA

RV

Inferior aspect of LV

Posterior septum

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3
Q

What does the left circumflex artery supply?

A

Left atrium

Posterior aspect of left ventricle

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4
Q

What does the left anterior descending artery supply?

A

Anterior aspect of left ventricle

Anterior septum

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5
Q

How can the 3 ACS syndromes be diffrentiated?

A

If have troponin rise and ST elevation or LBBB treat as STEMI

If have troponin rise and ST dep, T wave inversion, or deep Q waves treat as NSTEMI

Normal ECG and normal troponin = unstable angina or other cause

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6
Q

SS ACS

A

Chest pain for more than 15m

Radiates to shoulder, jaws, arms, back

N&V

Sweating

Heamodynamic instability (90/60) - Syncope

Feeling of impending doom

SOB

Palpitations

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7
Q

Who may have an ACS w/o chest pain?

A

Silent MI seen in diabetics

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8
Q

In the chest, the heart is positioned so the anterior heart is LA + LV.

Which artery supplies most of the anterior heart?

Which limb leads does this correspond to?

A

LAD artery

V1-V4

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9
Q

Which artery supplies the lateral heart?

Which leads does this correspond to?

A

Circumflex artery supplies lateral heart

1, AVL, V5, V6

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10
Q

Which artery supplies the inferior aspect of the heart and which leads does this correspond do?

A

RCA

2, 3, avf

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11
Q

Tests and Investigations for suspected ACS after acute management at the bedside?

A

Look for cause of chest pain: CV/ Resp/ GI/ exam, MSK and psych

All obs

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12
Q

Name 3 thrombolytic agents for NSTEMI

What is the significant side effect ass/ w/ them?

A

Alteplase

Tenecteplase

Streptokinase

Significant risk of bleeding

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13
Q

STEMI acute treatment

A

If present within 2h of symtom onset eligible for PCI = STEMI

If present later thrombolysis

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14
Q

NSTEMI acute treatment

A

BATMAN

Beta blocker (eg. lisinopril)

Aspirin 300mg

Ticagrelor 180mg

Morphine tritated to control pain

Anticoagulant = fondaparinux

Nitrates- GTN

GRACE score + PCI if medium or high risk of repeat ACS in next 6m

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15
Q

Which classification is used to assess whether PCI is required in ACS?

A

GRACE classification

Used to assess risk of death or repeat MI 6m after having an ACS

Under 5% = low

5-10% = medium

Over 10% = high

Used to guide who needs more intensive care + consider PCI within 4 days if medium or high risk and had NSTEMI

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16
Q

What are the complications of MI?

A

DREAD

Death

Rupture of heart septum and papillary muscles

Edema - HF

Arrythmia and aneurysm (left ventricular aneurysm - aneurysm forms in wall of left ventricle)

Dresslers syndrome

17
Q

What is Dresslers syndrome?

A

Localised immune response causing pericarditis 2-3w after MI

18
Q

Describe medical secondary prevention of ACS

A

6 A’s

Aspirin 75mg/d

Another anti-platelet clopidogrel or ticagrelor for 12m

Atorvastatin 80mg once daily

ACEi

Atenolol or other beta blocker

Aldosterone antagonist only if have HF (like eplerenone)

19
Q

Describe lifestyle secondary prevention of ACS

A

Reduce CVD RF

  • Smoking
  • Reduce unhealthy lipids in diet (mediterranean diet)
  • WL via cardiac rehabilitation program
  • Reduce OH consumption
  • Optimise treatment of co-morbid conditions (diabetes and hypertension)
20
Q

Tests and Investigations for suspected ACS after acute management, specifically bloods?

A

Bloods:

Always (FBC, UE, TFT, LFT, CRP, ESR)

Diagnostic (troponin I/T)

DDx (amylase)

Underlying cause (glucose, hba1c, fasting glucose, lipid profile)

21
Q

Tests and Investigations for suspected ACS after acute management, specifically imaging?

A

Imaging:

ECG

CXR

ECHO

CT coronary angiogram

22
Q

Symptoms of Dressler’s?

A

Pleuritic chest pain

Fever

23
Q

Signs of Dressler’s?

A

Pericardial rub (heart rubs against pericardium producing a grating sound)

24
Q

Complications of Dressler’s?

A

Pericardial effusion and tamponade

25
Q

ECG changes in Dressler’s?

A

ECG shows global ST elevation and T wave inversion

26
Q

Bloods in Dressler’s?

A

Raised inflammatory markers ESR and CRP

27
Q

Management of Dressler’s?

A

Manage with NSAIDS (aspirin and ibuprofen) and steroids

Pericardiocentesis may be required

acute & critical care cc (6 decks)

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