8. Acute Coronary Syndrome

Question 1

What is an acute coronary syndrome?

Answer 1

Suspected or confirmed acute myocardial ischaemia or infarction
includes STEMI, NSTEMI and unstable angina

Question 2

How long does unstable angina last for?

Answer 2

> 20 minutes at rest

Question 3

What are the diagnostic findings in unstable angina?

Answer 3

Non-specific ECG and normal cardiac enzymes

Question 4

What are the diagnostic criteria for an acute MI?

Answer 4

Change in enzymes combined with at least one piece of evidence of ischaemia

Question 5

What is the evidence of ischaemia in an acute MI?

Answer 5

ECG changes
Pathological Q waves
New loss of viable myocardium or new regional wall motion abnormality on ECHO

Question 6

How can an NSTEMI be seen on an ECG?

Answer 6

ST depression +/- T wave inversion

Question 7

How can a STEMI be seen on an ECG?

Answer 7

ST elevation or new LBBB

Question 8

What might result from a STEMI?

Answer 8

Ventricular septal rupture or mitral regurgitation

Question 9

What is the Levine sign?

Answer 9

Patient can’t describe the nature of their pain but places a clenched fist over their chest

Question 10

What atypical presentation is associated with an inferior wall infarct?

Answer 10

GI symptoms

Question 11

What leads does an inferior wall infarct show in?

Answer 11

2, 3, AVF

Question 12

What chest pain isn’t cardiac related?

Answer 12

pleuritic
Mid to low abdomen
Patient can point to it with one finger
Anything brought on by movement or touch
Pain radiates to lower extremities or above mandible

Question 13

What is the differential for an MI?

Answer 13

PE, pneumonia
Aortic dissection, pericarditis
GORD, cholecystitis
Costochondritis

Question 14

When does troponin rise after an injury and how long does it remain elevated for?

Answer 14

Rises after 3-8 hours

Remains elevated for 2 weeks

Question 15

What other conditions can increase troponin T?

Answer 15

Renal disease

Dermatomyositis

Question 16

When does the CK-MB isoenzyme rise and how long does it remain elevated for?

Answer 16

Rises after 4-6 hours

Remains high for 36-48hours

Question 17

What causes false positives in CK-MB?

Answer 17

Exercise, 
trauma, 
muscle disease, 
diabetes, 
PE

Question 18

What treatment is used for reperfusion in MI?

Answer 18

Percutaneous Coronary Intervention (stenting) within 2 hours
Thrombolysis in STEMI if PCI not available
Coronary artery bypass grafting if other 2 contraindicated

Question 19

What anti-platelet treatment is given post MI?

Answer 19

Aspirin and clopidogrel

Question 20

What anti-ischaemic therapy is given post MI?

Answer 20

Oxygen
Nitrate (vasodilation)
Morphine
B-blocker (reduce heart rate, BP and contractability)

Question 21

What is given as antithrombic therapy post MI?

Answer 21

LMWH

Question 22

What is given as lipid lowering therapy post MI?

Answer 22

Statins