ACS Flashcards

1
Q

Conditions

A

Unstable angina
STEMI
NSTEMI

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2
Q

Pathophysiology of STEMI

A

Atheromatous plaque that ruptures causing a thrombus which completely occludes coronary artery causing transmural ischaemia and necrosis

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3
Q

Types of STEMI

A

Type I - atherosclerotic plaque rupture with intraluminal thrombus

Type II - imbalance between myocardial oxygen supply and demand - respiratory failure

Type III - MI causing death when biomarkers aren’t available

Type IV - MI due to PCI

Type V - MI due to coronary artery bypass

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4
Q

Risk factors

A
Age 
Male
FHx < 55yo
Hypercholesterolaemia 
Previous MI 
Diabetes 
HF 
Bypass surgery 
Smoking 
Obesity
AF
HTN
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5
Q

HEART SCORE

A

Predicts 6 week risk of major adverse cardiac event

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6
Q

Q risk

A

Calculates probability of a MI or stroke in the next 10 years

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7
Q

GRACE score

A

Estimates the in hospital and 6 month to 3 year risk of mortality of patients with ACS

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8
Q

TIMI score

A

Estimates mortality for patients with unstable angina and NSTEMI

If high score - coronary angiography within 72hrs

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9
Q

Symptoms

A
Central dull crushing chest pain 
Radiates to arm and jaw 
Nausea and vomiting 
Sweating 
Gradual onset
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10
Q

STEMI investigations

A
Obs 
Bloods - Trop I, FBC, U+Es, LFTs 
Lipid profile 
Diabetic screen 
ECG - ST elevation 
Transthoracic echocardiogram 
CXR - pulmonary oedema 
Coronary angiogram - plaque rupture/ dissection 
CT aorta - query aortic dissection into RCA
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11
Q

ECG changes

A
Min - hours - tall T wave 
0 - 12 hours - ST elevation 
1 - 12 hours - pathological Q wave 
2 - 5 days - T wave inversion 
Weeks - months - T wave recovery
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12
Q

Acute management of STEMI

A

Morphine - 5 - 10mg IV
Oxygen
Nitrates - GTN spray
Aspirin - 300mg

PCI

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13
Q

Prasugrel contraindications

A

Over 75 yo

TIA or stroke

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14
Q

What medication is also given if morphine is administered?

A

Metoclopramide 10mg - antiemetic

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15
Q

When would fibrinolysis be given

A

If PCI cannot be done within 120mins and pt presented within 12 hours of onset of symptoms
- ECG 60-90 mins after

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16
Q

Long term medication

A
Aspirin - life long 
Ticagrelor - 12 months 
ACEi/ARB 
Beta blocker 
Statin - atorvastatin 80mg 
Risk factor reduction - smoking cessation, alcohol reduction, diabetes control
17
Q

NSTEMI pathophysiology

A

Rupture of the fibrous cap of the atheromatous plaque in a coronary artery, causing a thrombus which PARTIALLY occludes the artery causing ST elevation which leads to subendocardial ischaemia and necrosis

18
Q

GRACE Low risk NSTEMI management

A

Low risk - predicted 6 month mortality less than 3% GRACE score

  • consider conservative management without angiography
  • angiography may be beneficial in younger people
  • ticagrelor with aspirin or clopidogrel if high bleeding risk
19
Q

GRACE high risk NSTEMI management

A

Predicted 6 month mortality - 3%+

  • immediate angiography
  • follow on PCI if indicated within 72 hours
  • prasugrel or ticagrelor with aspirin
  • clopidogrel if already has indication for anticoagulants
  • LMWH - if having PCI
  • echocardiogram - left ventricular necrosis
20
Q

Cardiac rehabilitation

A
Diet modification - decreased salt and cholesterol 
Exercise 
Stress management 
Health education 
Alcohol reduction 
Smoking cessation
21
Q

ST elevation in leads II,III, AVF

A

Inferior STEMI

Right coronary artery

22
Q

ST elevation in leads V5,V6, AVL

A

Lateral STEMI

Left circumflex artery

23
Q

ST elevation in leads V1 - V4

A

Anterior STEMI

Left anterior descending artery (LAD)

24
Q

Complications

A

Another MI
HF
Ischaemic heart disease
Mitral regurgitation

25
What should be prescribed if statin in contraindicated
Ezetimibe
26
Which artery supplies the SAN and AVN
Right coronary artery
27
Contraindications for thrombolysis (AGAINST)
* Aortic dissection * GI bleeding * Allergic reaction previously * Iatrogenic: recent surgery * Neuro: cerebral neoplasm or CVA Hx * Severe HTN (200/120) * Trauma, inc. CPR
28
Thrombolysis agents
1st: streptokinase ( can only be given once) 2nd: alteplase
29
What else should be given with Fibrinolysis
Antithrombin drugs e.g. Fondaparinux | Repeat ECG should be given within 60 - 90 mins