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Cardiovascular System > ACS and AMI > Flashcards

ACS and AMI Flashcards

1
Q

What does plaque disruption lead to

A

Atherothrombosis formation

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2
Q

What does a rupture of an atherothrombosis cause (4)

A

Unstable angina
NSTEMI
STEMI
Sudden cardiac death

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3
Q

Why do plaques rupture (2)

A

Inflammation

Shear stress

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4
Q

What symptoms will a rupture give

A

Symptoms at rest

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5
Q

How would you diagnose ACS

A

Site of pain
Character of pain
Radiation sites
Aggravation

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6
Q

Non-modifiable Risk Factors for ACS (6)

A 
Age
Gender
Creed
Family History
Genetics
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7
Q

Modifiable Risk factors of ACS (5)

A 
Smoking
Diabetes Mellitus
Hyperlipidaemia
Hypertension
Lifestyle-exercise & diet
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8
Q

Atypical ACS Presentation NSTEMI (3)

A

Women
Elderly
Diabetes

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9
Q

Symptoms of NSTEMI (3)

A
  • Breathlessness alone +/- signs of heart failure
  • Nausea & Vomiting +/- other autonomic symptoms
  • Epigastric pain +/- recent onset indigestion
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10
Q

Diagnosis of NSTEMI- ECG (3)

A

May be normal
ST segment depression
T wave inversion

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11
Q

Diagnosis of NSTEMI-Biomarkers

A

Cardiac troponin

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12
Q

What does elevated cardiac troponin indicate

A

Myocyte damage

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13
Q

Immediate treatment form NSTEMI

A 
ABCDE
Morphine/Diamorphine
Oxygen
Nitroglycereine (GTN)
Aspirin
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14
Q

Antiplatelet therapy

A

Aspirin
Clopidogrel
Prasugrel
Ticagrelor

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15
Q

Anti-thrombotic therapy (3)

A

IV unfractioned heparin
LMW heparin
Given subcutaneously

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16
Q

Other medical therapy for ACS

A

Beta blockers
Statins
ACEI

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17
Q

What type of patients are given coronary revascularisation

A

UA/NSTEMI

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18
Q

Treatment of STEMI

A

PCI

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19
Q

When PCI cannot be performed what is the other option

A

Fibrinolytic Therapy within 90 minutes of calling or 30 minutes of hospital arrival

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20
Q

What patients have increased risk of bleeding and intra-cranial haemorrhage in some patients (7)

A
  • Age >75
  • Female
  • Previous stroke
  • Low body weight
  • SBP > 160 mmHg
  • INR > 4 (blood clotting)
  • Chronic disease and elevated creatine
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21
Q

When is thrombolysis best (2)

A

Door-balloon >90 minutes

<3 hour symptom onset

22
Q

Primary PCI is best (5)

A 
Door-ballon <90 minutes
>3 hour symptom onset
High 
Bleeding risk
Cardiogenic shock
Heart Failure
23
Q

Secondary Prevention treatment for ST elevated MI (General measures) (3)

A

Stop smoking
Diet
Exercise

24
Q

STEMI secondary prevention (co-morbidities) (2)

A

Control BP,

Glycaemic control

25
Q

Other secondary treatment for STEMI

A 
Aspirin
Clopidogrel
B-blockers
Statins
ACEI
26
Q

Treatment- inpatient investigations

A

EChO

27
Q

What are you looking for when using an ECHO

A

 Size of wall motion abnormality and whether hypokinetic or akinetic (partial or complete loss of muscle movement) ; overall contractility and also presence and degree of mitral regurgitation (inferiors)
 Presence of mural thrombus (antero-apical Mis)

28
Q

What are the 2 life threatening MI complications

A

Mechanical

Ventricular arrhythmic

29
Q

Mechanical Complications

A

Tearing or rupture of infarcted myocardium

30
Q

3 main complications of mechanicalcoomplications

A

Free wall rupture
Papillary muscle rupture
Rupture of IVS

31
Q

What are the consequences of free wall rupture

A

Edge ofinfarcted area
Haemopericardium
Acute tamponade

32
Q

Free wall rupture is more common in (4)

A

Elderly
Female
HBP
Anterior MI

33
Q

Papillary muscle rupture causes (2)

A

Inferior MI

Ant/Lat MI

34
Q

Symptoms and features of IVS rupture (6)

A 
Major haemodynamic compromise
Sudden severe breathlessness
Sweating
Nausea
Vomiting
Chest pains
35
Q

Signs of papillary muscle rupture (6)

A
  • Shock
  • Tachycardia
  • Pulmonary oedema
  • New harsh systolic murmur
  • Right parasternal heave
  • Palpable thrill, elevated JVP
36
Q

Investigations for mechanical complications

A

ECHO

Cath Lab

37
Q

Initial management of papillary muscle rupture (4)

A

IV nitrates
Inotropes
IABP- reduce afterload and augment DBP

38
Q

Surgery for Papillary Muscle Rupture (2)

A

Mitral valves are usually replaced

Coronary artery bypass is needed and possible

39
Q

Ventricular Arrhythmic Complications (3)

A

Ventricular Tachycardia
Ventricular Fibrillation
LV thrombus

40
Q

Ventricular Tachycardia

A

May be driven by MI or ischaemia

41
Q

Medical therapy for Ventricular Tachycardia

A

Implantable cardioverter defibrillator with anti-tachycardia pacing

42
Q

Ventricular Fibrillation

A

Multiple waves of electrical activity

Deteriorates into asystole

43
Q

What is the only effective treatment of VF

A

Defibrillation

44
Q

Once Asystole is reached what is difficult to restore

A

Cardiac Output

45
Q

Where is LV thrombus seen typically

A

aical/antero-apical MI

46
Q

Treatment of LV thrombus (3)

A

Anticoagulants and repeat and repeat echo

47
Q

Why does mechanical ruptures occur

A

Necrotic myocardial tissue is softest and most prone to rupture

48
Q

What is the consequence of the rupture

A 
Connection between the two ventricles 
Haemodynamic deterioration
Hypotension
Heart Failure
Cardiogenic Shock
49
Q

Rupture of the IVS causes a

A

left to right shunt

50
Q

A left to right shunt leads to

A

an overload of the right ventricles which eventually leads to overload of left ventricle

51
Q

During rupture of IVS the left ventricular function causes

A

Compensatory vasoconstriction

Systemic vascular resistance

Cardiovascular System (42 decks)

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