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Year 3 Cardiology > ACS > Flashcards

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
Q

What should be prescribed if statin in contraindicated

A

Ezetimibe

26
Q

Which artery supplies the SAN and AVN

A

Right coronary artery

27
Q

Contraindications for thrombolysis (AGAINST)

A
  • Aortic dissection
  • GI bleeding
  • Allergic reaction previously
  • Iatrogenic: recent surgery
  • Neuro: cerebral neoplasm or CVA Hx
  • Severe HTN (200/120)
  • Trauma, inc. CPR
28
Q

Thrombolysis agents

A

1st: streptokinase ( can only be given once)
2nd: alteplase

29
Q

What else should be given with Fibrinolysis

A

Antithrombin drugs e.g. Fondaparinux

Repeat ECG should be given within 60 - 90 mins

Year 3 Cardiology (11 decks)

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