ACS Flashcards

1
Q

What comes under ACS?

A

Unstable angina, NSTEMI, STEMI or sudden cardiac death

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2
Q

What are the features of a vulnerable plaque?

A
  • Thin fibrous cap
  • Inflam. cell infiltrates > proteolytic activity
  • Lipid-rich plaque
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3
Q

What are the features of a stable plaque?

A
  • Thick fibrous cap
  • SMC’s + more ECM
  • Lipid poor plaque
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4
Q

What happens when a plaque ruptures?

A

Platelet aggregation + activation > Thrombus

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5
Q

What causes platelet adhesion to endothelium?

A

BV exposed collagen > contact with platelet > release of TAXA2, ADP, Serotonin > chemokines cause platelets to change shape + express GBIIb.IIa receptor > once receptors activation of coag cascade = thrombin

Thrombin converts fibrinogen > fibrin = laid over platelets

Ruptured plaque > super adherent thrombus > can occlude BV > ACS

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6
Q

What is a STEMI and how is it treated?

A
  • Coronary artery blocked
  • Need to open BV
  • Mechanical (stent) + pharmacological
  • Aspirin + prasugrel/tricagrelor > cath lab > heparin
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7
Q

What is an NSTEMI and how is it treated?

A
  • Coronary artery not blocked
  • Pt acutely ischaemic
  • Treated with anti-platelet therapy then angiogram to find where to stent later
  • Aspirin + Clopidogrel
  • High risk = more potent antiplatelet - prasugrel/tricagrelor > cath lab > heparin
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8
Q

What is the purpose of anti-platelet therapy?

A

Reduce ability of blood to clot

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9
Q

What is the MOA of Aspirin?

A

Blocks COX in PGHS so no TXA2

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10
Q

What is the MOA of Clopidogrel?

A

ADP receptor blocker (ADP binding to platelets stimulates platelet aggregation)

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11
Q

What is the MOA of of Prasugrel?

A

ADP receptor blocker
Quicker + more potent
Metabolised by CYP450

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12
Q

What is the MOA of Tricagrelor?

A

Reversible ADP blocker

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13
Q

What are GBIIb.IIa inhibitors used for?

A

Most potent, only IV

Only used for STEMI in cath lab

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14
Q

What is the purpose of anti-coagulant therapy?

A

Prevents blood clots

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15
Q

What is the MOA of Heparin?

A

Complexes with antithrombin 3 (breaks down thrombin), making it more potent
Narrow therapeutic index

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16
Q

What is the purpose of low molecular weight heparin?

A

Can give 1 or 2 times a day subcutaneously with reduced incidence of heparin induced thrombocytopenia (HIP)

17
Q

What is main pro of using Xa inhibitors?

A

Much less bleeding

18
Q

How does the rate of metabolism between a thrombin inhibitor and heparin differ?

A

Thrombin inhibitor metabolised more quickly than heparin so less bleeding

19
Q

What does chest pain, ST depression/T inversion and a negative Tn suggest?

A

Unstable angina