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Cardiology > ACS > Flashcards

ACS Flashcards

1
Q

What conditions does AXS encompass?

A

STEMI
NSTEMI
unstable angina

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2
Q

Unmodifiable RFs for ACS

A

Inc age
Male
FH

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3
Q

Modifiable RFs for ACS

A 
Smoking
DM
HTN
Hypercholesterolaemia
Obesity
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4
Q

Pathophysiology of IHD

A

Initial endothelial dysfunction
Pro-inflammatory, pro-oxidant, proliferative and reduced NO
Fatty infiltration of sub endothelial space for LDL particles
Monocytes migrate from blood and become macrophages
These phagocytose LDL–> foam cells
Smooth muscle proliferation and migration from tunica media into intima
Results in a fibrous capsule covering fatty plaque

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5
Q

Symptoms of ACS

A

Central/L chest pain
Radiate to jaw or left arm
Heavy

Dyspnoea
Sweating
N+V

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6
Q

Different presentation of ACS in diabetic/elderly pts?

A

Silent! Asymptomatic!

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7
Q

Signs of ACS

A

Slight tachy

Pt may appear pale and clammy

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8
Q

2 most important Ix when assessing chest pain

A

ECG

Cardiac markers eg trop

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9
Q

ECG changes in V1-V4. Type of MI and coronary artery involved

A

Anterior, LAD

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10
Q

ECG changes in II,III, aVF. Type of MI and coronary artery involved

A

Inferior, right coronary

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11
Q

ECG changes in I, V5-6. Type of MI and coronary artery involved

A

Lateral, left circumflex

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12
Q

Diagnostic features of a STEMI

A

Clinical symptoms consistent w ACS

ECG changes in > 2 contiguous leads
2.5 mm (i.e ≥ 2.5 small squares)

ST elevation in leads V2-3 in men under 40 years, or ≥ 2.0 mm (i.e ≥ 2 small squares)

ST elevation in leads V2-3 in men over 40 years
1.5 mm ST elevation in V2-3 in women

1 mm ST elevation in other leads

New LBBB

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13
Q

Diagnostic features NSTEMI

A

Needs 2 of following
1)Cardiac chest pain

2) No ST elevation
ST depression or
T wave inversion or
Pathological Q waves

3) raised trops

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14
Q

When can we rule out STEMI/NSTEMI and diagnose unstable angina?

A

If trops are normal and ECG shows no pathological changes

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15
Q

Causes of raised trops (other than ACS)

A 
Chronic renal failure
Sepsis
Myocarditis 
Aortic dissection
PE
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16
Q

Acute STEMI treatment

A

Targeted O2 therapy aim >90%
Loading 300mg aspirin

Can also add 2nd antiplatelet such as clopidogrel 300mg or ticagrelor 180mg

Sublingual GTN spray
Morphine

Primary PCI (if available within 2 hrs AND within 12 hours of onset)
Thrombolysis (if PCI not available within 2 hrs)
17
Q

Thrombolysis medication examples?

A

Streptokinase, alteplase and tenecteplase

18
Q

Acute NSTEMI treatment

A

Targeted O2 therapy

Aspirin 300mg and fondaparinux

GRACE score calculated: anything other than lowest risk need ticagrelor or prasugrel

If high brisk bleed then PO clopidogrel 300mg

Morphine
Nitrates

19
Q

What type of drug do patients undergoing fibrinolysis also need

A

antithrombin

20
Q

Common management of ACS

A

PO Aspirin 300mg
O2 if <94
Morphine if severe pain
Nitrates- symptom relief

21
Q

If pt is hypotensive what medication should we be cautious of in ACS treatment?

A

Nitrates

22
Q

Management for NSTEMI is based on what tool?

A

GRACE
Age, HR, BP, cardiac and renal func, cardiac arrest on presentation
ECG findings
Trop levels

23
Q

Which patients with NSTEMI/unstable angina should have coronary angiography (with follow-on PCI if necessary)?

A

Immediate: the clinically unstable
Within 72 hrs: GRACE score >3% risk of future CV events
If ischaemia is experienced, angiography considered

24
Q

When do we do trops

A

Performed at least 3 hours after pain started and 6-12 hours after start of pain

25
Q

Post-MI mx 5 drugs

A

Aspirin 75mg OM+ 2nd anti-lately eg clopidogrel 75mg or ticagrelor 90mg

Beta blocker (bisoprolol)

ACEi

High dose statin (atorvastatin 80mg)

26
Q

Dressler’s syndrome- what is it? How does it present? How do we diagnose? How do we manage?

A

Post Mi syndrome
2-3 weeks post MI

Pericarditis

Pleuritic chest pain, fever, pericardial rub on auscultation

Can cause pericardial effusion and tamponade

ECG- global ST elevation and T wave inversion

Echo (effusion)

CRP and ESR

Mx: NSAIDs (high dose aspirin) maybe steroids

Cardiology (5 decks)

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