ACS Flashcards
List 20 differentials for chest pain.
-
Cardiac
- Pericarditis
- Myocarditis
- Myocardial contusion
- Ischaemic:
- AMI
- Unstable angina
- Stable angina
- Prinzmetal angina
- Aortic dissection
-
Pulmonary
- CAP
- PTX
- Pleurisy
- Pulmonary contusion
- PE
-
GI
- PUD
- Borhaave’s syndrome
- GORD/oesophageal spasm
- Gastritis/oesophagitis
- Biliary colic/cholecystitis
- Pancreatitis
- Mallory-Weiss
-
MSK
- Muscle pain
- RIb/sternum #
- Costochondritis
-
Skin
- Herpes zoster
List the 5 types of MI.
- Type I: Spontaneous MI - plaque rupture, thrombus, dissection
- Type II: Ischaemia - Flow not meeting demand - spasm, arrhythmia, hyper/hypotension, anaemia, CA embolism
- Type III: Sudden, unexpected cardiac death - HOCM, may be Type I but death occurs before bloods taken for labs
- Type IV: PCI-related
- Type V: CABG related
Name and outline a classification system for angina.
Canadian CV Society Angina Classification System:
Class I: no angina with ordinary physical activity;
Class II: slight limitation of normal activity as angina occurs with walking, climbing stairs, or emotional stress;
Class III: severe limitation of ordinary physical activity as angina occurs on walking one or two blocks on a level surface or climbing one fight of stairs in normal conditions;
Class IV: inability to perform any physical activity without discomfort as anginal symptoms occur at rest.
What criteria must be met to diagnose an acute, evolving or recent MI?
- Rise and fall in troponin, PLUS one of:
- Ischaemic symptoms,
- ECG changes:
- Ischaemic ECG changes : T-wave changes, STE or STD
- Development of pathologic Q-waves
- Regional wall motion abnormality on echo
- PCI demonstrated occulsion
List traditional and non-traditional RFs for CAD.
Traditional:
- Age
- Male gender
- Smoking
- DM
- Cholesterol
- HTN
- Family hx of CAD
- Cocaine use
- Early or artificial menopause
Non-traditional
- Lupus
- RA
- HIV
List 5 RFs for atypical presentation of ACS.
- Female gender
- Age >85y
- DM
- Dementia
- No previous hx of CAD
- Non-caucasians
List 8 early complications of AMI.
Think RHYTHYM problems, PUMP problems, SYSTEMIC problems
- Bradyarrhythmia / AV blocks
- Tachyarrhythmias
- Cardiogenic shock
- LV free-wall rupture
- Septum rupture
- Papillary mm rupture
- Infarct pericarditis (not same as Dresslers)
- Embolic stroke
- Hypoglycaemia
- Iatrogenic
- Drug adverse effects -> bleeding
- PCI -> femoral bleeds, aneurysm
Describe the progression of ECG changes in STEMI.
- Hyperacute T-waves
- ST depression
- ST depression
- Inverted T-waves
- Pseudonormalisation of T-waves
- Pathologic Q-waves
***Dynamic ECG changes***
List the regions that show reciprocal changes for each of the following infarct territories.
Posterior
Anterior
Inferior
Lateral
Septal
Remember PAILS
Posterior MI -> Anterior
Anterior MI -> Inferior
Inferior MI -> Lateral
Lateral MI -> Septal
What are the ECG findings of LMCA occlusion?
- Widespread STDep
- STE >1mm in aVR, OR
- STE in aVR >V1
List ten causes of STE.
Think:
Normal variant
Abnormal heart
Abnormal body
Normal variants
- Normal variant
- BEREPOL
- LV paced rhythym
Abnormal heart
- LVH
- Acute MI
- Prinzmetal angina
- Brugada
- Pericarditis
- LV aneurysm
Abnormal
- HyperK
- PE
- ICH
- Hypothermia
- Post cardioversion
List three groups of people who are more likely to have atypical symptoms of ACS.
- Women
- DM
- Non-Caucasians
Give 5 causes of hyperacute T-waves.
- Ischaemia -> first ECG change of ischaemia is hyperacute T-waves
- Hyper K+
- Pericarditis
- BERepol
- LBBB
- LVH
Give 8 causes of STE.
Normal
- BERepol
- Normal variant
Abnormal heart
- AMI
- Pericarditis
- LBBB
- LV paced rhythym
- LVH
- LV aneurysm
- Prinzmetal angina
- Post electrocardioversion
- Brugada syndrome
Abnormal body
- ICH
- PE
- Osborn waves (of hypothermia)
List the three ECG features that suggest posterior MI.
- STD in V1-3
- Dominant R-wave (R:S) in V2 (reciprocal q-wave)
- Upright T-wave in V1-3
