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CR3 > ACS > Flashcards

ACS Flashcards

1
Q

What is included in ACS?

A

Unstable Angina
NSTEMI
STEMI

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2
Q

Pathophys of an NSTEMI or unstable angina?

A

Ruptured coronary plaque with subocclusive thrombus

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3
Q

Pathophy of a STEMI?

A

Ruptured coronary plaque with occlusive thrombus

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4
Q

What is the treatment for STEMI?

A

Emergency reperfusion preferable with primary percutaneous intervention

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5
Q

Difference in ECGs between STEMI and NSTEMI/unstable angina?

A
  • STEMI = ECG ST elevation or new LBBB

- NSTEMI/unstable angina = ECG normal or ST depression

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6
Q

Troponin

A

Biomarker for cardiac necrosis

Isoforms I and T

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7
Q

Definition of an MI

A

Rise and/or fall of troponin with at least 1 value >99th percentile of the URL plus 1 of

  • myocardial ischaemia symptoms
  • ECG changes
  • loss of myocardium/wall motion abnormality by imaging
  • angiography/autopsy showing intracoronary thrombus
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8
Q

Type 1 AMI

A

Spontaneous

Plaque Rupture

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9
Q

Type 2 AMI

A

Ischaemic imbalance

Coronary spasm, embolism, dissection, hypotension

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10
Q

Type 3 AMI

A

Cardiac death

Presumed AMI

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11
Q

Type 4a AMI

A

Related to PCI

>5 times URL for troponin

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12
Q

Type 4b AMI

A

Caused by stent thrombosis

Confirmed at angiography or autopsy

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13
Q

Type 5 AMI

A

Related to CABG

>10 times URL for troponin

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14
Q

What is the AMI pathway?

A

2-7 day long

Emergency admission, diagnose, hospital admission to treat, stay to manage comp., discharge with prevention and rehab

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15
Q

Danger in delay in calling help

A

33% die from AMI before reaching hospital

elderly, women, nocturnal pain, no previous AMI, diabetic > risk

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16
Q

Anatomical determinants of infarct size

A
  • occluded artery distribution

- proximity of coronary occlusion

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17
Q

Physiological determinants of infarct size

A
  • thrombotic response to plaque rupture

- thrombolysis effectiveness

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18
Q

Logistical determinants of infarct size

A
  • time to call help, arrive to hospital, delivery of reperfusion therapy
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19
Q

Therapeutic determinants of infarct size

A
  • reperfusion therapy (thrombolysis vs. PPCI)
  • antiplatelets
  • drugs to prevent against LV remodelling
20
Q

A&E ACS Urgent treatment

A
  • consider alternative sinister illness
  • ECG, oxygen, bloods, aspirin, GTN
  • if STEMI = PPCI straight away
  • if unstable angina/NSTEMI = troponin, ECG, symptom, risk scores
  • nondiagnostic = continue evaluation until seek cardiology help
21
Q

When to admit a patient in A&E for chest pain?

A
  • diagnostic ECG
  • typical chest pain/HF/unstable rhythm
  • troponins positive
22
Q

STEMI Treatment

A 
PPCI
Aspirin + Ticagrelor 
Gp IIb/IIIa inhibitor
UH/LMWH
Give all drugs with cath lab to have procedure
23
Q

Ticagrelor

A

P2Y12 receptor antagonist
Higher antiplatelet activity
Fast onset action
180mg loading dose then 90mg twice daily

24
Q

P2Y12 receptor antagonists

A

Clopidogrel lowest activity then prasugrel then ticagrelor

25
Q

NSTEMI low risk <3% treatment

A

conservative management
aspirin
fondoparinux/UFH
Ticagrelor

26
Q

NSTEMI intermediate risk 3-6% and high risk >6% treatment

A 
aspirin
fondoparinux/UFH
ticagrelor
consider tirofiban/eptifibatide
coronary angiography within 96 hours to assess PCI or CABG
27
Q

Complication Treatment of HF

A
  • diuretics = IV furosemide, haemofiltration if diuretic resistant
  • RAS inhibiton = ACEi, ARB, eplerenone
  • ionotropes = NA, dobutamine
  • LV support device = balloon pump, LVAD
28
Q

What bradyarrthymias can you get from AMI?

A

Complete AVN block
Wenckebach Mobitz 1
Intermittent block of both bundle branches (Mobitz 2)
Complete block of both bundle branches

29
Q

How to treat Mobitz 1 and complete AVN block?

A

Atropine
Good prognosis
Spontaneous recovery <7d

30
Q

How to treat Mobitz 2 and complete BBB both sides?

A

Pacing

Poor prognosis

31
Q

What tachyarrythmias do yo get from AMI?

A

AF
VT - in first 12-24hrs
VF

32
Q

How to treat AF from AMI?

A

Beta blocker
DC cardioversion if haemodynamically unstable
Anticoagulation if persists

33
Q

How to treat VT and VF from AMI?

A

DC shock for rhythm control
If corrected = minor prognostic impact
>24 hours occur bad prognosis

34
Q

AMI secondary prevention

A 
Lifestyle = smoking, diet, exercise
Drugs = aspirin, P2Y12 receptor antagonists, statins, beta blocker, ACEi
Prevention = ICD
35
Q

Which treatments do you give for life?

A 
Aspirin
Statins
Beta blockers
ACEi
All except P2Y12 receptor ant.
36
Q

What to do if patient death pre hospital?

A

Defib ASAP

Most due to VF

37
Q

What to do if hospital death from LVF?

A

Initiate reperfusion therapy ASAP
Aldosterone antagonists
Avoid calcium antagonists
Treat HTN and renal failure

38
Q

What artery is affected in a lateral STEMI?

A

Circumflex artery

39
Q

What artery is affected in an anterior STEMI?

A

LAD

40
Q

What artery is affected in an inferior STEMI?

A

RCA

41
Q

Causes of high troponin

A 
Cardiac procedures
HTN associated heart disease
CKD
Tachycardias
Myocarditis
Cardiomyopathies
AF
42
Q

When do troponin levels change?

A

Increase in 3-12 hours
Peak in 24-48 hours
Return to normal in 5-14 days

43
Q

Which drugs are given for pain

A

morphine

GTN

44
Q

CK levels change how?

A

Rises in 3-12 hours
Peaks in 24 hours
Returns to baseline in after 48-72 hours

45
Q

Symptoms

A

Typical Chest Pain
Complications = arrhythmia
HF
LVF

CR3 (30 decks)

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