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Cardiology > ACS > Flashcards

ACS Flashcards

1
Q

What does ACS encompass?

A

Unstable angina
NSTEMI
STEMI

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2
Q

What is the process of atherosclerotic plaue formation?

A
  • Accumulation of LDL cholesterol in inner layers of blood vessels
  • Leukocytes adhere to the endothelium and enter the intima, where they combine with lipids to become foam cells
  • Artery remodelling, calcification and foam cells cause plaques to form
  • Rupture of a plaque causes platelet activation, thrombus formation and coronary artery occlusion
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3
Q

What is a type 1 MI?

A

MI due to artheromatous plaque formation

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4
Q

What is a type 2 MI?

A

MI due to hypoxia (increased oxygen demand or decreased supply)

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5
Q

What ECG changes can be seen in unstable angina?

A

Can be normal
ST depression
T wave inversion

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6
Q

What ECG changes can be seen in NSTEMI?

A

May be normal
ST depression
T wave inversion

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7
Q

What are the non-modifiable risk factors for ACS?

A

Age
Male
Family history
South Asian or Afro-Carribean ethnicity

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8
Q

What are the modifiable risk factors for ACS?

A

Smoking
Diabetes
Hypertension
Hyperlipidaemia
Obesity
Sedentary lifestyle
Recreational drug use

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9
Q

What is the presentation of ACS?

A

Central, crushing chest pain
Radiation to left arm or neck
Shortness of breath
Sweating
Nausea and vomiting
Palpitations
Anxiety

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10
Q

What are the primary investigations for ACS?

A

ECG
Troponin - troponin is measured at baseline and 4 hours

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11
Q

What are alternative causes of raised troponin?

A

CKD
Sepsis
Myocarditis
Aortic dissection
Pulmonary embolism

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12
Q

Where does the left coronary artery correspond to on ECG?

A

I, aVL, V3-V6

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13
Q

Where does the LAD correspond to on ECG?

A

V1-V4

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14
Q

Where does the circumflex artery correspond to on ECG?

A

I, aVL, V5-V6

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15
Q

Where does the right coronary artery correspond to on ECG?

A

II, III, aVF

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16
Q

Where does the circumflex artery supply?

A

Left atrium
Posterior aspect of left ventricle

17
Q

Where does the LAD supply?

A

Anterior aspect of left ventricle
Anterior aspect of septum

18
Q

Where does the right coronary artery supply?

A

Right atium
Right ventricle
Inferior aspect of left ventricle
Posterior septal area

19
Q

What ECG changes can be seen in a STEMI?

A

ST segment elevation
New left bundle branch block

20
Q

What other investigations may be useful in the diagnosis of ACS?

A

FBC, U&E, LFT, lipids, glucose
CXR to exclude other causes of chest pain
Echocardiogram once stable

21
Q

What is the initial mangement of ACS?

A

Oxygen if sats < 94
Morphine
GTN
Aspirin 300mg

22
Q

What is the GRACE score?

A

A score that gives the 6 month probability of death after an NSTEMI
- Patients with above 3% are considered for early angiography with PCI

23
Q

What is the diagnostic investigation for ACS?

A

Coronary angiography

24
Q

What is the management of STEMI within 120 minutes?

A

PCI

25
Q

What is the management of STEMI after 120 minutes?

A

Thrombolysis with alteplase/tenecteplase
Unfractionated heparin

26
Q

What are the early complications of ACS?

A

Post-MI pericarditis
Ventricular fibrillation (cardiac arrest)
Cardiogenic shock
Mitral regurgitation (secondary to papillary muscle rupture)
Left ventricular wall rupture

27
Q

What are the late complications of ACS?

A

Dressler’s syndrome - presents similar to post-MI pericarditis
Heart failure
Left ventricular aneurysm

28
Q

What is the presentation of Dressler’s syndrome?

A

Pleuritic chest pain
Low-grade fever
Pericardial rub on auscultation

29
Q

What is the management of Dressler’s syndrome?

A

NSAIDs
Prednisolone in severe cases

30
Q

What is the presentation of left ventricular aneurysm post-MI?

A

Persistent ST elevation and left ventricular failure

Cardiology (17 decks)

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