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My own anatomy > ACS - presentation and management > Flashcards

ACS - presentation and management Flashcards

1
Q

What is ACS

A

New onset of a collection of symptoms related to a problem with the coronary arteries

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2
Q

What do the CA supply?

A

Myocardial cells

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3
Q

What does an ACS cause?

A

Myocardial Ischaemia

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4
Q

What is stable angina caused by?

A

‘Stable’ Coronary leison

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5
Q

What are stable anginal symptoms relieved by?

A

Rest

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6
Q

What are acute coronary syndromes caused by?

A

Unstable coronary leison

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7
Q

How do you diagnose ACS?

A

Detection of cardiac cell death (troponin) AND:

  • Symptoms of ischaemia
  • New ECG changes
  • Evidence of coronary problem on coronary angiogram or autopsy
  • Evidence of new cardiac damage on another test
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8
Q

What is a type 1 MI?

A

Spontaneous MI associated with ischamia and due to a primary coronary event such as plaque erosion, rupture, fissuring or dissection

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9
Q

What is a type 2 MI?

A

Due to imbalance in supply and demand of oxygen. Result of Ischaemia but not ischaemia from thrombosis of CA

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10
Q

What is a type 3 MI?

A

Sudden cardiac death, Including cardiac arrest, with symptoms of ischaemia, accompanied by new ST elevation or LBBB. Verified coronary thrombus by angiography or autopsy but death occurring before blood samples could be obtained or before biomarkers appear in the blood

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11
Q

What is a type 4a MI?

A

MI associated with PCI. PCI related crease of biomarkers greater than X 99th percentile of the upper reference limit is by convention defined as MI

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12
Q

What is a type 4b MI?

A

MI associated with verified statement stent thrombosis via angiography or autopsy

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13
Q

What is a type 5 MI?

A

MI associated with CABG, >5 x99th percentile upper reference limit plus new Q waves or LBB or imaging of new loss

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14
Q

What does LBBB stand for?

A

Left bundle branch block, - a cardiac conduction abnormality seen on the electrocardiogram (ECG). In this condition, activation of the left ventricle of the heart is delayed, which causes the left ventricle to contract later than the right ventricle

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15
Q

What type of MI would a vasospasm or endothelial dysfunction be?

A

MI Type 2

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16
Q

What type of MI would a fixed atherosclerosis and supply-demand imbalance by?

A

MI Type 2

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17
Q

What type of MI would be a plaque rupture with thrombus be?

A

MI Type 1

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18
Q

What type of MI would be a supply-demand imbalance alone?

A

MI Type 2

19
Q

Describe the history of a patient with a STEMI?

A
  • Ischaemic sounding heart pain
  • May radiate to neck/arm
  • OFten deny it is a ‘pain’, more of a ‘discomfort, weight or tightening’
  • May be associated with nausea, sweating and breathlessness
20
Q

What does the initial ECG of a person with a complete coronary occlusion show?

A

ST elevation?

21
Q

What does the ECG at 3 days show after a complete coronary occlusion?

A

Q waves

22
Q

what does the initial ECG of a partial coronary occlusion show?

A

ST depression
T wave inversion
May be normal

23
Q

What does the mECG of a partial coronary occlusion at 3 days show?

A

No Q waves

24
Q

What may show/not be shown on an ECG of a posterior MI

A

As the posterior wall supplied by the left circumflex artery may not see any ST elevation anywhere, even if LCx is completely blocked

25
Q

If a posterior MI is suspected what investigation is reccomended?

A

Put ECG leads on back of chest - will see opposite changes in leads however

26
Q

What is the goal of reperfusion therapy?

A

To open a blocked artery

27
Q

What is a mechanical reperfusion therapy?

A

PCI

28
Q

What is a pharmacological reperfusion therapy?

A

Thrombolysis

29
Q

What are the risks of thronbolysis?

A

Bleeding

30
Q

When to not give thrombolysis

A

If recent stroke, or ever had a previous intracranial bleed

Caution if had recent surgery, on warfarin, or severe hypertension

31
Q

How to decide if thrombolysis or cath lab for stemi?

A

If you can get to cath lab within 2 hours, then dont give thrombolysis

32
Q

What are the investigations for an NSTEMI?

A 
Serial ECG's
- As to not miss an evolving STEMI or a posterior STEMI
Blood tests
- Troponin
- Cholesterol levels
33
Q

What are the possible treatment options for an ACS with no ST elevation?

A 
GTN
Opiates
Antithrombotic drugs with a P2Y12 antagonists
Anticoagulant drugs
Beta blockers
Statins
ACEI
34
Q

GTN effects

A

Vasodilator - opens up CA

- Wont help if artery is completely blocked

35
Q

How can GTN be given?

A

Sub-lingual or as IV

36
Q

Opiate (morphine) effects

A

Helps relieve anxiety

Helps venodilate which may have haemodynamic benefits

37
Q

Describe the procedure of dual antiplatelet therapy for an NSTEMI

A 
Aspirin
PLUS ONE OF P2Y12 Receptor antagonists:
- Clipiodogrel 
- Tricagrelor 
- Prasugrel
38
Q

Describe the dosing of aspirin?

A

300mg loading dose - unless already on, then 75mg

39
Q

Describe the dosing of clopidogrel?

A

300mg loading dose, then 75g

40
Q

Describe the dosing of tricagrelor?

A

180mg loading dose, then 90mg

41
Q

Describe the dosing of prasugrel

A

60 mg loading dose, then 10mg

42
Q

What is the effect of anti-coagulant drugs?

A

Prevent fibrin formation

43
Q

What procedure is given to those with NSTEMI unless frail/elderly?

A

Coronary angiogram

44
Q

What is the management for someone with a NSTEMI

A
  • Keep attached to a cardiac moniter for first 24-48 hours
  • Listen to new murmurs and signs of heart failure every day
  • Start ‘secondary prevention’ medication
  • Do an echo

My own anatomy (34 decks)

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