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MS4 - CVS > ACS > Flashcards

ACS Flashcards

1
Q

ACS includes?

A

Unstable angina
NSTEMI
STEMI

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2
Q

Pathophysiology of ACS

A

Plaque rupture

Thrombosis and inflammation

Rarely coronary spasm

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3
Q

Modifiable risk factors of ACS

A
  • HTN
  • DM
  • Smoking
  • ↑cholesterol
  • Obesity
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4
Q

Non-modifiable risk factors of ACS

A
  • age
  • male
  • FH (MI <55 years)
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5
Q

Sx of ACS

A
  • Radiates to left jaw or arm
  • Nausea
  • Sweating
  • Dyspnoea
  • Palpitations
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6
Q

Other symptoms for diabetic patients who may present without chest pain

A
  • Syncope
  • Delirium
  • Post-op oliguria / hypotension
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7
Q

Differential diagnosis of ACS

A

Angina

Peri- / Endo- / Myocarditis

Aortic dissection

PE

Pneumothorax

Pneumonia

GORD

Anxiety

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8
Q

ECG changes for STEMI

A
  • Normal
  • ST elevation
  • Q waves: full-thickness infarct
  • T wave inversion
  • New onset LBBB
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9
Q

ECG changes for NSTEMI

A
  • ST depression
  • T wave inversion
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10
Q

No Q waves on ECG indicates?

A

subendocardial infarct

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11
Q

Bloods for ACS

A

1) Troponin T/I
2) FBC, U+E, glucose, lipids, clotting

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12
Q

What is Troponin T/I?

A

Myofibrillar proteins linking actin and myosin

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13
Q

When to measure troponin

A

Elevated from 3-12h
Need 12h trop to exclude MI
Peak 24h

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14
Q

CXR for suspected ACS

A
  • Cardiomegaly
  • Pulmonary oedema
  • Widened mediastinum: aortic rupture
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15
Q

When to diagnose unstable angina

A
  • typical symptoms
  • no ST elevation
  • negative troponin
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16
Q

Rx of STEMI

A

PCI or thrombolysis

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17
Q

Rx of NSTEMI or unstable angina

A

Medical + elective angioplasty ± PCI/CABG

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18
Q

ECG criteria for thrombolyis

A
  • ST elevation > 1mm in 2+ limbs

or > 2mm in 2+ chest leads.

  • New LBBB
  • Posterior: Deep ST “depression” and tall “R” waves in V1-V3
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19
Q

Flow chart of STEMI management

A

1) 12 lead ECG
2) O2
3) IV access + bloods
4) Brief assessment
5) Aspirin 300mg
6) Morphine + anti-emetic
7) Nitrates
8) LMWH
9) Admit to CCU
10) PCI / thrombolysis

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20
Q

Complications of PCI

A
  • Bleeding
  • Emboli
  • Arrhythmia
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21
Q

CIs of thrombolysis

A

Severe HTN (200/120)

Aortic dissection

GI bleeding

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22
Q

Agents used in thrombolysis

A

Alteplase

Rh t-PA

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23
Q

What should patients not receiving any form of reperfusion therapy be given?

A

fondaparinux

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24
Q

Continuing therapy following STEMI

A

Aspirin 300mg 2 wks

Then clopidogrel 75mg (1 month) + aspirin 75mg (lifelong)

ACEi within 24hrs of MI

Beta blocker

Statin

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25
Advice following STEMI
- Stop smoking - Diet - Exercise
26
How long to avoid work post MI?
2 months
27
How long to avoid sex post MI?
1 month
28
How long to avoid driving post MI?
4 wks | (6 wks if bus or lorry driver)
29
Complications of MI DRAPPED
Death Rupture Arrythmias / Aneurysm Pericarditis Pump failure Embolism Dressler's syndrome
30
Causes of death from MI
VF LVF Stroke
31
Presentation of pericarditis following MI
- Occurs early - Mild fever - Central chest pain / change in pain - Relieved by sitting forward - Pericardial friction rub
32
ECG changes of pericarditis following MI
- Saddle-shaped ST elevation - ± PR depression
33
Treatment of pericarditis following MI
- NSAIDs (ibuprofen) - Echo to exclude effusion
34
Types of rupture following MI
- Cardiac tamponade - Papillary muscle/chordae → Mitral Regurgitation - Septum
35
Features of septum rupture
- pansystolic murmur - ↑JVP - Heart failure
36
Types of tachycardias following MI
SVT VT
37
Types of bradycardia following MI
Sinus bradycardia AV block Ventricular bradycardia
38
Presentation of ventricular aneurysm following MI
- 4-6wk - LVF - Angina - Recurrent VT - Systemic emboli
39
ECG changes consistent with ventricular aneurysm
persistent ST elevation
40
Rx for ventricular aneurysm following MI
- Anticoagulate - consider excision
41
Definition of Dressler's syndrome
Pleuropericarditis
42
Cause of Dressler's syndrome
Auto-antibodies vs myocyte sarcolemma
43
Presentation of Dressler's syndrome
2-6wks - Recurrent pericarditis - Pleural effusions - Fever - Anaemia - ↑ESR
44
Rx of Dressler's syndrome
- NSAIDs - steroids if severe
45
Causes of IHD
Atheroma Anaemia AS Arteritis
46
RFs for IHD
HTN DM Smoking Hypercholesterolaemia Obesity Age Male FH of MI \<55yrs Hyperlipidemia
47
Sx of IHD
Central crushing chest pain Relieved by rest Radiation to left arm/jaw
48
Classification of angina
Stable Unstable Decubitus Prinzmetal's / variant Syndrome X
49
Stable angina definition
Induced by exercise
50
Unstable angina definition
Occurs at rest
51
Decubitus angina definition
Induced by lying down
52
Prinzmetal's angina definition
Occurs at rest Due to coronary spasm
53
ECG changes in Prinzmetal's angina
ST elevation during attack Resolves as pain subsides
54
Syndrome X angina definition
Angina pain + ST elevation on exercise test No evidence of coronary atherosclerosis Probably represents small vessel disease
55
Differentials of angina
AS Aortic aneurysm GORD
56
Secondary prevention of CHD
Aspirin 75mg OD ACEi Statins Antihypertensives GTN PRN
57
Anti-anginal medication
GTN + B blocker or Ca channel blocker
58
CABG indications
L main stem disease Triple vessel disease Refractory angina Unsuccessful angioplasty
59
PCI indications for angina
Poor response to medical Rx Not suitable for CABG
60
Diltiazem
Ca channel blocker
61
Verapamil
Ca channel blocker

MS4 - CVS (8 decks)

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