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B2. Cardiovascular System > ACS & AMI - Presentation & Investigation > Flashcards

ACS & AMI - Presentation & Investigation Flashcards

1
Q

What does ACS stand for?

A

Acute coronary syndrome

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2
Q

What is acute coronary syndrome?

A

Any sudden event suspected or proven to be related to a problem with the coronary arteries

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3
Q

What is any sudden event suspected or proven to be related to a problem with the coronary arteries called?

A

Acute coronary syndrome

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4
Q

What is myocardial ischaemia?

A

Reduction in the blood supply to the heart muscle

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5
Q

What is reduction in the blood supply to the heart muscle called?

A

Myocardial ischaemia

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6
Q

What is 2?

A

Right coronary artery

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7
Q

What is 3?

A

Left anterior descending coronary artery

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8
Q

What is 4?

A

Circumflex coronary artery

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9
Q

What is 5?

A

Left coronary artery

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10
Q

What does AMI stand for?

A

Acute myocardial infarction

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11
Q

What is acute myocardial infarction?

A

Cell death due to ischaemia

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12
Q

What is cell death due to ischaemia called?

A

Acute myocardial infarction

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13
Q

What cause of death is heart disease in Scotland?

A

2nd most common cause of death

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14
Q

What can acute myocardial infarction be due to?

A

Complete or partial coronary artery occlusion

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15
Q

What is cardiac arrest?

A

Abnormal heart rhythm that is not compatible with life

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16
Q

What is an abnormal heart rhythm that is not compatible with life called?

A

Cardiac arrest

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17
Q

What are examples of cardiac arrest?

A

Ventricular fibrillation or tachycardia

Asystole

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18
Q

What is asystole?

A

Cardiac flatline so total state of cessation of electrical activity from the heart, more serious form of cardiac arrest and usually irreversible

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19
Q

What is a cardiac flatline, so total state of cessation of electrical activity from the heart called?

A

Asystole

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20
Q

When can cardiac arrest occur in relation to myocardial infarction?

A

Can occur during the acute phase or later afterwards

It may also be unrelated to myocardial infarction

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21
Q

What is a ‘heart attack’?

A

Public use to cover all manner of sudden cardiac onset

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22
Q

What is a word the public use to cover all manner of sudden cardiac events?

A

Heart attack

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23
Q

What do doctors usually think heart attack means?

A

Myocardial infarction

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24
Q

What is the process of the evolution of atherosclerosis?

A

1) Foam cells
2) Fatty streak
3) Intermediate lesion
4) Atheroma
5) Fibrous plaque
6) Complicated lesion/rupture

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25
What is an example of chronic ischaemic heart disease vs examples of acute coronary syndrome?
Chronic ischaemic heart disease - stable angina Acute coronary syndromes - unstable angina, myocardial infarction (STEMI and NSTEMI)
26
What is the difference in the blockage of arteries in chronic ischaemic heart disease and acute coronary syndromes?
Chronic ischaemic heart disease (such as stable angina) - less of lumen blocked Acute coronary syndromes (such as unstable angina then myocardial infarction) - more of lumen blocked
27
How does complete coronary occlusion affect the ECG initially and after 3 days?
Initially - ST elevation After 3 days - Q waves
28
How does partial coronary occlusion affect the ECG initially and after 3 days?
Initially - no ST elevation After 3 days - no Q waves
29
How does the thickness of the damage to the heart muscle change for STEMI and NSTEMI?
NSTEMI - only partial thickness damage of the heart muscle STEMI - full thickness damage of the heart muscle
30
What is other terminology for STEMI myocardial infarction?
Q wave MI Transmural MI
31
What is other terminology for NSTEMI myocardial infarction?
Non Q wave MI Subendocardial MI
32
What does the diagnosis of myocardial infarction require?
Detection of cardiac death/injury and one of: Symptoms of ischaemia New ECG changes Evidence of coronary problem on coronary angiogram or autopsy Evidence of new cardiac damage on another test
33
How can cardia death/injury be detected?
Cardiac biomarkers
34
What are examples of different cardiac biomarkers?
Myoglobin Troponin CK-MB
35
Is more troponin present in STEMI or NSTEMI myocardial infarction?
STEMI
36
Does troponin increase always mean myocardial infarction?
No, there are many other causes
37
Other than myocardial infarction, what other things could cause an increase in troponin?
Pulmonary embolism Cardiac contusion Anaemia Sepsis Renal failure Sub-arachnoid haemorrhage
38
What is cardiac contusion?
Bruise of the heart muscle
39
What is a bruise of the heart muscle called?
Cardiac contusion
40
What are the different categories of myocardial infarction?
1 2 3 4a 4b 5
41
What is a type 1 myocardial infarction?
Spontaneous MI associated with ischaemia adn due to primary coronary event
42
What is a type 2 myocardial infarction?
Due to imbalance in supply and demand of oxygen, not ischaemia due to coronary event
43
What is a type 3 myocardial infarction?
Sudden cardiac death, with symptoms of ischaemia accompanied by new ST elevation Verified coronary thrombus after death
44
What is a type 4a myocardial infarction?
MI associated with percutaneous coronary intervention
45
What is a type 4b myocardial infarction?
MI associated with verified stent thrombosis via angiography or autopsy
46
What is a type 5 myocardial infarction?
MI associated with CABG
47
What could cause a type 1 myocardial infarction?
Coronary atherosclerosis Coronary vasospasm Coronary dissection Embolism of material down coronary artery Inflammation of coronary artery Previous radiotherapy to chest causing fibrosis and stenosis of coronary arteries
48
What could cause a coronary vasospasm?
Cocaine Triptans 5-FU
49
Who usually suffers from coronary dissection?
Younger, healthy females
50
What could cause inflammation of coronary arteries?
Vasculitis
51
What is seen in the history for acute coronary syndrome?
Chest pain (may radiate to neck/arm) Nausea Sweating Breathlessness
52
What are some risk factors for acute coronary syndrome?
Male Age Known heart disease Known high blood pressure High cholesterol Diabetes Smoker Family history
53
54
Are males or females more at risk of acute coronary syndrome?
Males
55
What are some examination findings for acute coronary syndrome?
Look completely fine or very unwell No specific features to find Ensure you check heart rate, blood pressure and listen for murmurs and crackles in the chest
56
What are key investigations for acute coronary syndrome?
ECG
57
What does an ECG tell you about acute coronary syndrome?
Where the problem is
58
What are some different locations of myocardial infarction?
Lateral Anterior Posterior
59
Why can posterior myocardial infarctions easily be missed?
No ECG leads on posterior chest
60
What is a STEMI myocardial infarction caused by?
Completely occluded artery
61
What does STEMI myocardial infarction cause?
Ongoing myocyte death
62
What is the treatment for STEMI myocardial infarction?
Get coronary artery open as soon as possible: Angioplasty (mechanical) Thrombolysis (pharmacological)
63
What are some risks of thrombolysis?
Bleeding Don't give if recent stroke or ever had a previous intracrainal bleed Caution if recent surgery, on warfarin, severe hypertension
64
When should thrombolysis never be given?
If had a recent stroke or ever had a previous intracranial bleed
65
When does thrombolysis work best?
When given earlier
66
What is generally the best option for treating STEMI myocardial infarction?
Angioplasty unless cannot get to the lab within 2 hours - then thrombolysis
67
Compared to STEMI, what do NSTEMI patients tend to be?
Older More likely to have previous MI More likely to have other medical problems
68
What are signs of unstable angina?
Rapidly worsening Occuring at rest ECG may be normal or abnormal No cell death so troponins will not be raised
69
What is the process of general management for acute coronary syndrome?
1) Admit to hospital 2) Cardiac monitor 3) Give oxygen only if levels are low
70
What investigations are done for acute coronary syndrome?
ECG (consider doing posterior leads) Blood tests (check troponin, Hb, kidney function and cholesterol)
71
What should be check in blood tests for acute coronary syndrome?
Troponin Haemoglobin Kidney function Cholesterol
72
What is the treatment for acute coronary syndrome?
Glycerol trinitrate (GTN) Opiates Anti-thrombotic drugs Beta blockers Statin ACE inhibitors
73
What does GTN stand for?
Glycerol trinitrate
74
What effect does glycerol trinitrate (GTN) have?
Vasodilator (opens up coronary arteries)
75
How can GTN be administered?
Sublingual or IV infusion
76
What is an example of an opiate?
Morphine
77
Why are opiates given for acute coronary syndrome?
Relieves anxiety Helps venodilate
78
What are the different categories of anti-thrombotic drugs?
Anti-platelet drugs Anti-coagulant drugs
79
What are examples of anti-platelet drugs?
Aspirin Clipidogrel
80
What are examples of anti-coagulant drugs?
Heparin Low molecular weight heparin (LMWH) Fondaparinux
81
Why are beta blockers used for acute coronary syndrome?
Reduces the work the heart has to do
82
What do statins do?
Lower cholesterol
83
Why are ACE inhibitors given for acute coronary syndrome?
Helps the heart muscle recover
84
Do patients with an NSTEMI myocardial infarction always need a coronary angiogram?
They often do, use common sense
85
What are some risks of coronary angiography and angioplasty/stenting?
Bleeding Blood vessel damage Myocardial infarction Coronary perforation Stroke Dye affecting kidney function (contrast neuropathy)
86
What does PCI stand for?
Percutaneous coronary intervention
87
What does CABG stand for?
Coronary artery bypass graft
88
What surgical options are there for revascularisation?
Percutaneous coronary intervention (PCI) Coronary artery bypass graft (CABG)
89
What are some possible complications following myocardial infarction?
Arrhythmia Mechanical such as myocardial rupture, acute ventricular septal defect and mitral valve dysfunction due to papillary muscle rupture)
90
What are some possible longer term consequences following myocardial infarction?
High risk of further myocardial infarction/death Cardiac failure Risk of bleeding as on anti-platelet drugs Potential delay in getting other operations when on anti-platelet drugs

B2. Cardiovascular System (41 decks)

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