ACS Flashcards

1
Q

What is ACS?

A
Unstable angina (present at rest)
Myocardial infarction
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What ist he underlying pathology in ACS?

A

Athersclerotic plaque rupture
Exposure of blood to thrombogenic materiall
Thrombosis and inflammation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is myocardial infarction?

A

Myocardial cell death, releasing troponins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is ischaemia?

A

Lack of blood supply

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

How can you differentiate unstable angina and MI?

A

MI has troponin rises, unstable angina does not

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What indicates STEMI vs NSTEMI?

A

STEMI -aCS with ST segment elevation or new onset LBBB

NSTEMI - trop positive ACS without ST segment elevation, ECG may show ST depression, T inversion, non-specific changes or be normal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are risk factors for ACS?

A

Non-modifable: Age, male, Fox of IHD

Modifiable: smoking, hypertension, hyperlipidaemia, DM, obesity, sedentery lifestyle, cocaine use

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

How is MI diagnosed?

A

Increase in cardiac biomarkers (troponin, creatine kinase)
Symptoms of ischaemia, ECG changes of new ischaemia, development of pathological Q waves, new loss of myocardium, regional wall motion abnormalities on imaging

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are symptoms of MI?

A

Acute central chest pain > 20 minutes
Crushing, tight, radiates to arm, shoulder, jaw, neck
Associated with nausea, sweatiness, dyspnoea, palpitations,

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

How do silent MIs present?

A

Syncope, pulmonary oedema, epigastric pain, vomiting, post-operative hypotension or oliguria, delirium, stroke

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are signs of MI?

A
Distress
Anxiety
Pallor
Sweatiness
Tachycardia/bradycardia
Hyper/hypotension
4th heart sound
Signs of heart failure (raised JVP, 3rd heart sound, gallop rhythm, basal crepitations)
Pansystolic murmur
Low grade fever

Later: pericardial rub or peripheral oedema

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What tests would you do for MI?

A

Bedside:
ECG

Blood:
FBC, U&E, glucose, lipids, cardiac enzymes - troponin, CK

Imaging: Echocardiogram - regional wall abnormlaities

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are differentials for chest pain?

A
Stable angina
Pericarditis
Myocarditis
Takotsubo cardiomyopathy
Aortic dissection
PR
Oesophageal reflux/spasm
Pneumothorax
MSK
Pancreatitis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

When does MI have worse prognosis?

A

Elderly
LV failure
ST changes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Describe the ECG changes in MI

A
STEMI
Hours - ST elevation, hyper acute (tall) T waves OR new LBBB
Dats - T wave inversion
Weeks = ST normal, T wave inversion
Months - Pathological Q wave
NSTEMI
ST depression
T wave inversion
Non-specific changes
Normal
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are troponin?

A

Proteins involved in cardiac and skeletal muscle contraction - controls when myosin can bind to the actin chain to shorten and contract muscle fibres.

When myocardial cells are damaged, cardiac troponin are released and enter the blood.

17
Q

Which troponin are specific to the heart?

A

Troponin T and I

18
Q

How doe troponin levels change in ACS? What other conditions raise troponin, how does this differ?

A

Troponin levels rise in the hours following the insult.
Troponin can be raised with myocarditis, pericarditis, ventricular strain. In these conditions, troponin levels are likely to change little as the insults are ongoing.
Can be raised iatrogenically following CPR, DC cardio version, ablation therapy

Also can be raised by PR, SAH, burns or sepsis, renal failure - important to look at change in troponin not just level

19
Q

What else can you measure biochemistry?

A

Creatine kinase

20
Q

How is NSTEMI differentiated from unstable angina?

A

Troponin are raised in MI not in angina.