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Cardiovascular System > ACS & AMI - Presentation & Investigation > Flashcards

ACS & AMI - Presentation & Investigation Flashcards

1
Q

What are the four main acute coronary syndromes (ACS)?

A

STEMI
NSTEMI
unstable angina
sudden cardiac death (SCD)

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2
Q

An ACS causes problems due to the effects of ________ _________.

A

myocardial ischaemia

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3
Q

Myocardial infarction (MI) implies cell death due to _________ _________.

A

prolonged ischaemia

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4
Q

What is cardiac arrest?

What are features of a cardiac arrest? (3)

A

Abnormal heart rhythm not compatible with life.

Ventricular fibrillation
Ventricular tachycardia
Asystole

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5
Q

Is a cardiac arrest the same as an MI?

A

Not necessarily, a cardiac arrest can occur during the acute phase of MI, in the late stage or be unrelated at all.

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6
Q

What are the three main coronary arteries affected in MI?

A
  • left anterior descending (LAD) artery
  • right coronary artery (RCA)
  • circumflex artery
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7
Q

What stage of atherosclerosis results in stable angina?

3

A
  • there is a stable fixed plaque, some occlusion but not completely blocked.
  • fibrous cap acts as protection.
  • no rupture or thrombus production.
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8
Q

What ACS’s are the diagnosis when there is thrombus present in the coronary artery?

A

STEMI

NSTEMI

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9
Q

Is stable angina is not considered an ACS, what is it?

A

chronic ischaemic heart disease

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10
Q

What would be picked up on an initial ECG where there is complete coronary occlusion?

What type of ACS is this?

A

ST elevation

STEMI

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11
Q

What would be picked up on an initial ECG where there is partial coronary occlusion?

What type of ACS is this?

A

No ST elevation
(ST depression)

NSTEMI

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12
Q

What has likely been the ACS if no pathological Q waves are picked up on an ECG 3 days following initial ECG?

A

NSTEMI

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13
Q

If an ECG is showing pathological Q waves, what is the likely cause?

A

There has been a STEMI (transmural MI)

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14
Q

What are the other clinical terms for STEMI/NSTEMI?

A

STEMI: transmural MI

NSTEMI: subendocardial MI

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15
Q

What main investigations are used to diagnose a MI?

2

A
  • bloods

- ECG

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16
Q

What blood result would indicate a recent/ongoing MI?

be specific

A
  • increased troponin

Troponin I, Troponin T

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17
Q

Which troponin is indicative of STEMI?

A

B1/Troponin I

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18
Q

Which troponin is indicative of NSTEMI?

A

B2/Troponin T

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19
Q

What are other causes of increased troponin levels, other than coronary artery disease?

(5)

A
  • arrhythmia
  • cardiac contusion
  • renal failure
  • sepsis
  • pulmonary embolism
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20
Q

Briefly, what defines a type I MI?

2

A
  • spontaneous MI

- associate with ischaemia due to thrombus, rupture, fissuring or dissection.

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21
Q

Briefly, what defines a type II MI?

2

A
  • imbalance in O2 supply and demand

- ischaemia, but not due to thrombosis.

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22
Q

Briefly, what defines a type III MI?

2

A
  • sudden cardiac death

- confirmed iscahemia, thrombus on angiogram or autopsy.

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23
Q

What are causes of type I MI other than atherosclerosis?

4

A
  • vasospasm
  • coronary dissection
  • embolism (air, fat)
  • vasculitis (inflammation)
24
Q

What information can be gathered from the history which points to MI?

(4/5)

A
  • chest pain (more like a discomfort)
  • pain radiation (jaw, arm)
  • severe, but not agony

associated symptoms: SOB, sweating, nausea

25
Q

What are the common cardiac risk factors?

8

A
  • Male
  • Age
  • Known heart disease
  • High BP
  • High cholesterol
  • Diabetes
  • Smoker
  • FHx of premature heart disease
26
Q

What should be included in the examination of a patient with suspected MI?

(2)

A
  • BP, HR (both arms)

- auscultation

27
Q

What should you listen for on auscultation of the heart?

2

A

murmurs or crackles

28
Q

What findings on an ECG may be indicative of a STEMI?

2

A

ST elevation

pathological Q waves

29
Q

What findings on an ECG may be indicative of a NSTEMI?

4

A

ST depression
inverted T waves
No Q waves
May be normal

30
Q

An inferior MI indicates occlusion of which coronary artery?

A

RCA

31
Q

A posterior MI indicates occlusion of which coronary artery?

A

circumflex branch

32
Q

An anterior MI indicates occlusion of which coronary artery?

A

LAD artery

33
Q

Which MI can be easy to miss on an ECG?

A

posterior MI/circumflex branch

34
Q

Which ECG leads are used to detect anterior MI?

A

V1, V2, V3, V4

35
Q

Which ECG leads are used to detect inferior MI?

A

SLL 2, SLL 3, aVF

36
Q

Which ECG leads are used to detect a lateral MI?

A

V5, V6

37
Q

Which ECG leads are used to detect a high lateral MI?

A

SLL 1, aVL

38
Q

What could be changed in order to detect a posterior MI more easily?

A
  • Position leads on back

- see opposite results on opposite leads (i.e. V1, V2)

39
Q

What is the surgical treatment options for MI?

Would this be used in STEMI or NSTEMI?

A

PCI (percutaneous coronary intervention)

STEMI mainly, NSTEMI possibly but not immediately important.

40
Q

If a NSTEMI patient was not having immediate PCI, how would they be treated?

(2)

A
  • fondaparinux

- LMWH s/c

41
Q

What treatment option would be required if a patient was not near a cath lab for PCI?

Which drug might be used for this?

A

thrombolysis

tenecteplase (TNK)

42
Q

What risks are associated with thrombolysis?

When should it not be given to patients? (3)

A
  • bleeding
  • recent stroke or previous intercranial bleeding
  • on warfarin
  • recent surgery
  • severe hypertension
43
Q

What are classical symptoms of unstable angina?

How will an ECG appear?

How will troponin be affected?

A
  • chest pain at rest
  • rapidly worsening

normal or abnormal

unchanged - no cell death

44
Q

As well as checking troponin blood levels, what other blood tests should be investigated?

(3)

A
  • Hb
  • cholesterol
  • kidney function
45
Q

What is the pharmacological treatment for MI?

A

MONA B

  • Morphine
  • Oxygen (if hypoxic)
  • Nitrate (GTN)
  • Anticoagulants/antiplatelett
  • Beta-blockers
46
Q

What antiplatelet might be prescribed?

What other medicine might be given along with this? (hint: it begins with a)

A

aspirin

antiemetic

47
Q

What are other antiplatelet drugs that may be prescribed?

(hint: __grel)

(3)

A

Clopidogrel

Ticagrelor Prasugrel

48
Q

What anticoagulant drugs are used in treating MI?

hint: to treat NSTEMI before PCI

A
  • heparin
  • LMWH
  • fondaparinux
49
Q

What drugs are prescribed to MI patients on discharge?

4

A
  • aspirin
  • ACE inhibitor
  • beta-blocker (or CCB)
  • statin
50
Q

What risks are associated with coronary angiogram and PCI?

6

A
  • Bleeding from access site
  • Blood vessel damage
  • MI
  • Coronary perforation
  • Stroke
  • Contrast nephropathy
51
Q

If PCI was an unsuitable surgical option, what else may be considered?

A

CABG

52
Q

What are post-MI complications?

A

C PEAR DROP

Cardiac arrhythmia/shock

Pericarditis
Emboli
Aneurysm
Rupture of ventricle

Dressler’s syndrome
Rupture of free wall
Papillary muscle rupture

53
Q

How does AF present? (2)

What does it increase patient risk of?

A
  • irregularly irregular pulse
  • ECG no P waves, narrow QRS complex

Stroke

54
Q

What can myocardial rupture lead to (rupture of free wall)?

A

cardiac tamponade

55
Q

What can papillary muscle rupture lead to?

A

mitral regurgitation

56
Q

Elevated troponin indicates what?

A

myocardial cell death, MI

57
Q

What is the most important investigation in MI?

A

ECG

Cardiovascular System (37 decks)

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