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Cardiac > Acute cardiac problems > Flashcards

Acute cardiac problems Flashcards

1
Q

What are the 3 types of ACS

A

Unstable Angina
ST Elevation Myocardial Infarction (STEMI)
Non-ST Elevation Myocardial Infarction (NSTEMI)

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2
Q

What is acute coronary syndrome

A

Ischaemia to the heart muscle usually as a result of a thrombus (usually made of platelets) from an atherosclerotic plaque blocking a coronary artery.

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3
Q

What does the left coronary artery become

A

left anterior descending and circumflex

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4
Q

What does the right coronary artery supply

A

Right atrium
Right ventricle
Inferior aspect of left ventricle
Posterior septal area

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5
Q

What does the LAD supply

A

Anterior aspect of left ventricle

Anterior aspect of septum

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6
Q

What does the circumflex supply

A

Left atrium

Posterior aspect of left ventricle

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7
Q

What features are required to diagnose a STEMI

A
  • ST elevatinon
  • New LBBB
  • Raised troponins
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8
Q

What features are required to diagnose an NSTEMI

A
  • ECG Changes: ST depression, T wave inversion, pathological Q waves
  • raised troponins
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9
Q

What features are required to diagnose unstable angina

A
  • May have ECG changes

- Troponins are NOT raised

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10
Q

What are the symptoms of ACS

A

Central crushing chest pain lasting for >20 mins with:

  • Nausea and vomiting
  • Sweating and clamminess
  • Feeling of impending doom
  • Shortness of breath
  • Palpitations
  • Pain radiating to jaw or arms
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11
Q

Name other causes of raised troponins

A 
Chronic renal failure
Sepsis
Myocarditis
Aortic dissection
Pulmonary embolism
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12
Q

Which vessel is involve in anterolateral ischaemia

A
  • Lead I, aVL, V3-6

- LCA

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13
Q

Which vessel is involve in anterior ischaemia

A
  • V1-4

- LAD

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14
Q

Which vessel is involve in lateral ischaemia

A
  • I, aVL, V5-6

- Circumflex

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15
Q

Which vessel is involve in inferior ischaemia

A
  • II, III, aVF

- RCA

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16
Q

Other than troponins and ECG what other investigations should you do in ACS

A

Physical Examination: heart sounds, signs of heart failure, BMI
FBC: anaemia
U&Es: prior to ACEi and other meds
LFTs: prior to statins
Lipid profile
Thyroid function tests (check for hypo / hyper thyroid)
HbA1C and fasting glucose (for diabetes)

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17
Q

What imaging should you obtain in ACS

A

Chest xray: other causes of chest pain & pulm oedema
Echocardiogram: assess the functional damage
CT coronary angiogram: assess for coronary artery disease

18
Q

What is the Management of an acute STEMI

A

Presentation within 12 hours of onset

  • Primary PCI (if available within 2 hours of presentation)
  • Thrombolysis (if PCI not available within 2 hours)
  • discuss with local cardiac centre as to whether they want aspirin/ticegralor etc
19
Q

What is PCI

A

Percutaneous Coronary Intervention (PCI) involves putting a catheter into the patient’s brachial or femoral artery, feeding that up to the coronary arteries under xray guidance and injecting contrast to identify the area of blockage. This can then be treated using balloons to widen the gap or devices to remove or aspirate the blockage. Usually a stent is put in to keep the artery open.

20
Q

What is thromblyisis

A

njecting a fibrinolytic medication (they break down fibrin) that rapidly dissolves clots. There is a significant risk of bleeding which can make it dangerous. Some examples of thrombolytic agents are streptokinase, alteplase and tenecteplase.

21
Q

Acute management of an NSTEMI

A 
B; beta blockers
A: Aspirin 300mg (Stat)
T: Ticegralor/clopidogrel 180/300mg (stat)
M: morphine
A: Anticoagulant: LMWH
N: nitrates
Oxygen if sats <95%
22
Q

What is the Grace score

A 
6-month risk of death or repeat MI after having an NSTEMI:
<5% Low Risk
5-10% Medium Risk
>10% High Risk
If medium, PCR within 4 days
23
Q

What are the complications of MI/HF

A 
D – Death
R – Rupture of the heart septum or papillary muscles
E – “Edema” (Heart Failure)
A – Arrhythmia and Aneurysm
D – Dressler’s Syndrome
24
Q

What is Dresslers Syndrome/post-myocardial infarction syndrome

A
  • Localised immune response causing pericarditis 2-3 post MI
25
Q

How does Dresslers Syndrome/post-myocardial infarction syndrome present

A
  • Pleuritc chest pain
  • low grade fever
  • pericardial rub
  • Pericardial effusion
  • rarely -> pericardial tamponade
26
Q

How do you diagnose Dresslers Syndrome/post-myocardial infarction syndrome

A
  • ECG: Global ST elevation
  • Echo: pericardial effusion
  • CRP/ESR: raised
27
Q

What is the management of Dresslers Syndrome/post-myocardial infarction syndrome

A
  • NSAIDs
  • Steroids: if severe
  • pericadiocentesis if large effusion
28
Q

What is the secondary preventing of ACS

A

A: aspirin 75mg OD
A: Anti-platlet (another): e.g. clopidogrel or ticagrelor for up to 12 mo
A: Atorvastatin 80mg OD
A: ACEi: ramipril titrated as tolerated to 10mg OD
A: Atenolol (or other beta blocker titrated as high as tolerated)
A: Aldosterone antagonist for those with clinical heart failure

29
Q

What lifestyle changes should you recommend to prevent secondary ACS

A

Stop smoking

  • Reduce alcohol consumption
  • Mediterranean diet
  • Cardiac rehabilitation (a specific exercise regime for patients post MI)
  • Optimise treatment of other medical conditions (e.g. diabetes and hypertension)
30
Q

What is acute left ventricular failure

A

left ventricle is unable to pump blood through the left side of the heart and out into the body. This causes a backlog of blood that increases the amount of blood stuck in the left atrium, pulmonary veins and lungs leading to pulmonary oedema

31
Q

What is pulmonary oedema

A

Vessels in the lungs become engorged with blood and the increased pressure causes interstitial fluid to leak into the lung tissue and alveoli which can’t re resorbed interfering with normal gas exchange

32
Q

Symptoms of pulmonary oedema

A
  • Rapid onset SOB
  • SOB exacerbated by lying flat
  • Type 1 respiratory failure
  • cough: frothy white/pink sputum
  • Looks unwell
33
Q

What are the triggers of pulmonary oedema

A

Iatrogenic (e.g. aggressive IV fluids in frail elderly patient with impaired left ventricular function)
Sepsis
Myocardial Infarction
Arrhythmias

34
Q

What may you see on examination in pulmonary oedema

A

Increase respiratory rate
Reduced oxygen saturations
Tachycardia
S3
Bilateral basal crackles (sounding “wet”) on auscultation
Hypotension in severe cases (cardiogenic shock)

35
Q

What signs do you see in right sided heart failure

A 
Raised Jugular Venous Pressure (JVP) (a backlog on the right side of the heart leading to an engorged jugular vein in the neck)
Peripheral oedema (ankles, legs, sacrum)
36
Q

What is B-type Natriuretic Peptide (BNP)

A

hormone that is released from the heart ventricles when the cardiac muscle (myocardium) is stretched beyond the normal range. Finding a high result indicates the heart is overloaded (with blood) beyond its normal capacity to pump effectively.

37
Q

What does B-type natriuretic peptide BNP do

A
  1. relax the smooth muscle in bv
  2. reduces the systemic vascular resistance
    3 .Heart can pump blood easier
  3. Acts as diuretic to increase urine excretion
38
Q

Other causes of a raised B-type natriuretic peptide BNP

A 
Tachycardia
Sepsis
Pulmonary embolism
Renal impairment
COPD
39
Q

What is ejection fraction

A

The percentage of the blood in the left ventricle is squeezed out with each ventricular contraction. An ejection fraction above 50% is considered normal.

40
Q

What is the management of acute LVF

A

Pour SOD

  • Pour away (stop) their IV fluids
  • Sit up
  • Oxygen
  • Diuretics: 40mg furosemide stat
  • monitor fluid balance

Consider:

  • NIV: CPAP
  • Inotropes
41
Q

What do inotropes do?

A

Inotropes strengthen the force of heart contractions and improve heart failure, however they need close titration and monitoring.

Cardiac (7 decks)

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