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Year 4 Cardiology > 5. Acute Coronary Syndrome > Flashcards

5. Acute Coronary Syndrome Flashcards

1
Q

What are the two types of acute coronary syndromes?

A

Unstable angina and myocardial infarctions

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2
Q

What is the common underlying pathology that they both share?

What are some other causes of ACS?

A

Plaque rupture, thrombosis and inflammation

Emboli, coronary spasm or vasculitis

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3
Q

How do you differentiate between unstable angina and myocardial infarction?

A

MI- rise in troponin

Unstable angina- no rise in troponin

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4
Q

What are the two types of myocardial infarctions?

Which is worse and why?

A

NSTEMI- worse due to the fact the coronary artery is completely blocked

STEMI-

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5
Q

How sensitive of a biochemical marker is troponin?

A

Very good and can differentiate between skeletal and cardiac muscle injury- GP online

Not specific- gynae surgeon ❓

Best used 10-12 hours after event, can use pre troponin assays if needed- NICE

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6
Q

What are some risk factors that cause MI’s

A 
Age
Being a man
Family history of IHD
smoking
Hypertension
Diabetes
Obesity/sedentary lifestyle
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7
Q

What troponins are most specific to the heart?

A

Troponins I and T

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8
Q

What (other than MI) can raise troponin levels?

A

Myocarditis, pericarditis, ventricular strain, discrete tchyarrhythmias

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9
Q

What are the symptoms of an MI?

A

Acute central chest pain lasting> 20 mins

May come with nausea, sweatiness, dyspnoea, palpitations, distress and anxiety

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10
Q

What is a silent MI?

How does it present?

A

MI without chest pain, more common in diabetics or the elderly

Syncope
Pulmonary odema
Epigastric pain
Hypotension (post-op)
Acute confusion
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11
Q

What tests are done for an MI?

A

ECG
Cardiac enzymes
Echo

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12
Q

What are the differential diagnosis for an MI?

A 
Stable angina
Pericarditis
Myocarditis
Takotsubo
Aortic dissection
Oesophageal reflux
Pneumothorax, pancreatitis
MSk pain
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13
Q

What categorised how acute coronary syndrome is treated?

A

If it is ST elevated or not

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14
Q

How do you manage symptoms?

A

GTN/opiates

GTN infusion?

Seek help if pain worsening or heart failure

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15
Q

What risk factors can be modified post event?

A

Advise to stop smoking

Identify and treat diabetes mellitus, hypertension, hyperlipidemia

Advise a diet high in oily fish fruit, vegetables and fibre and low in sat fats

Encourage exercise and do cardiac rehab

Flag mental health to GP if suspected anxiety or depression

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16
Q

What cardiprotective medications are there after an MI?

A 
aspirin and a second antiplatlet
Anticoagulate
B blockers 
Ace-I
Statin
17
Q

Who gets PCI after an MI

A

STEMI or high risk nstemi patients should receive immediate angiography and PCI

If multi vessel disease consider CABG

18
Q

What advice is given in driving and return to work?

A

1 week after angioplasty or 4 weeks if no angioplasty
(Unless the drive more than car/motorbike)

Job- depends on job and clinical condition. Aim for phased return with reduced manual labour

19
Q

What emergency complications can arise after ACS?

A

Cardiac arrest
Cardiogenic shock
Left ventricular failure

20
Q

Bradyarrythmias are a complications of MI . How are they treated?

A

Sinus bradycardia
1st degree block
Wenckeback phenomenon (No pacemaker)

Type 2 block
Complete AV block
Bundle branch block (Pacemaker)

21
Q

Why are Tachyarrhymias a complication of MIs

What are they?

A

Decreased potassium, hypoxia and acidosis all cause arrhythmias

Sinus tachycardia
SVT
AF
Premature ventricular contraction
Non sustained and sustained VT
22
Q

Right ventricular failure are a complication of an MI. How are they treated?

A

Prestos with low cardiac output and raised JVP

Avoid vasodilator and diuretics
Encourage fluid

23
Q

Pericarditis is a complication of an MI. How are they treated?

A

NSAIDS

24
Q

What are some other complications of an MI?

A

Cardiac tamponade
Mitral regurgitation
Ventricular spiral defect
Dresselers syndrome- recurrent pericarditis, PE’s, fever, anaemia

Year 4 Cardiology (18 decks)

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