ACS

Question 1

Coronary angiography

Answer 1

We access the arterial artery through peripheral artery could be initially femoral Nowdays standard is radial artery , we place against the blood flow catheters that are tubes that we are able to inject contrast.
We place this catheters at the origin of the aorta and into the coronary artery Ostia and we inject contrast and we look different radiological incidents ,contrast means radio opaque substance and try to characterise the anatomy of coronary arteries and associated anomalies

Question 2

Acute coronary syndrome

Answer 2

Suspicion acute ischaemia with or without infarction

Question 3

Atherothrombosis

Answer 3

UA,Stroke,SCD,AMI,Peripheral Ischaemia

Question 4

Criteria for type 1 MI due to atherothrombosis

Answer 4

1. Symptoms AMI
2. New ischemic ECG changes
   - > severe degree 02 supply decrease
3. increased troponin
4. Path.Q waves
5. Image : loss myoc
6. Thrombus identification

Question 5

Type 2 MI

Answer 5

Secondary to illness e.g. Anemia,hypotension,shock

Due to atherosclerosis,vasospasm,02 supply decreased , increased O2 demand
so 02 supply is not the main mechanism

Question 6

Type 3 MI

Answer 6

SCD
Died before blood sample
When autopsy reveals MI -

Question 7

Type 4A MI

Answer 7

• coronary intervention

- new ischemic changes

Question 8

Type 4B MI

Answer 8

• stent thrombosis

Question 9

Type 4C MI

Answer 9

-Interstent re stenosis

Question 10

Troponin rise/fall

Answer 10

With ischemia-> acute MI -> ATS / thrombosis

W/o ischemia -> AMI

Question 11

ACS W/o ST elevation

Answer 11

NSTEMI,UA

Question 12

ACS With ST elevation

Answer 12

STEMI , NON Q,Q-AMI

Question 13

AMI vs US

Answer 13

Increased biomarkers myoc.necrosis (Tn)

Question 14

NSTEMI vs STEMI

Answer 14

Incomplete +/- intermittent coronary occlusion

Question 15

AMI

Answer 15

1. Acute chest discomfort, retrosternal
2. Radiates to left arm, neck, Jaw
3. Sweating ,dyspnea, nausea syncope
4. Cardiac arrest
5. Electric instability : VAS,Bradyarrhythmia,SVT
6. Pneumodynamic shock(cardiogenic)
7. Systemic embolism due to LV thrombi ( UA < AMI)

Question 16

ECG

Answer 16

• ST changes: persistent: STEMI , new LBBB
• T wave inversion or flat
• new q wave or loss R wave ( STEMI vs NSTEMI )
• pseudonormalisation of T wave

Question 17

NSTEMI

Answer 17

ST segment depression ,transient ST elevation ,

Isolated T wave inversion

Question 18

Biomarkers

Answer 18

-Troponin: N <0.4 μg/L-> Tachyarrh,HF,HTN,Myoc.
- LV dysfunction: BNP/NT -pro-BNP
-CRP
OTHERS: CBC , HbAic,eGFR: Creatinine, lipids ,chol

Question 19

Persistent occlusion

Answer 19

Release enzymes slow

Question 20

Rule out

Answer 20

Angiography,stress test,CCTA

Question 21

Echo

Answer 21

-Can be normal
-New ventricle wall motion a anomalies
Effect on LVEF
- Complications:MR, left ventricle wall rapture, tamponade coma left ventricle thrombus
-Additional : Contrast echo -> decreased perfusion,stress test ,XRay,CCTA,SPECT,CMRI

Question 22

Culprit lesion

Answer 22

Not a logical features suggestive of acute plaque rupture)

1. Intraluminal filling defects consistent with thrombus
2. Plaque ulceration
3. Plaque irregularly

Question 23

Type UA

Answer 23

De novo < 3M,class II,III
At rest (esp. > 20”)-> MI
CRESCENDO( class III)
Early postAMI
noctural 
Prinzmetal

Question 24

Positive Tall R waves in V1,V2 or early R wave transition

Answer 24

WPW syndrome for left accessory pathway

Question 25

If it is a transient occlusion the release of enzyme will be

Answer 25

earlier and the peak will be earlier and the persistence will be shorter

Question 26

Additional Imaging Methods

Answer 26

Useful for differential diagnosis and/or unraveling latent myocardial ischemia 
- Chest X-RaY
- CT
CCTA
-SPECT
-cMRI ( stress)