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Medicine I: Cardiology > Acute & Chronic Coronary Syndromes > Flashcards

Acute & Chronic Coronary Syndromes Flashcards

1
Q

What is ischaemia?

A

the restriction of blood flow to the coronary arteries

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2
Q

what percentage of the lumen has to be occluded to be symptomatic?

A

50% of the diameter; 75% of the cross-sectional area

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3
Q

components of a plaque

A

soft lipid core and fibrous cap

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4
Q

components of the lipid core

A

LDL and cholesterol

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5
Q

what are foam cells?

A

macrophages that have eaten up too much cholesterol and lipid to toxic amounts

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6
Q

how is a thrombus formed?

A
  • platelet aggregation which starts through singular fibrin links and the formation of a white thrombus
  • this breaks off due to the bursting of the foam cells and release of proteases from the cells, the thrombus then occludes small arterioles
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7
Q

characteristics of an NSTEMI

A
  • rise in troponin
  • ST depression
  • chest pain
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8
Q

treatment for angina

A
  • antiplatelets eg aspirin/clopidogrel

- anticoagulants eg LMWH

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9
Q

white vs red thrombi

A
  • red thrombi have a tighter, more organised fibrin matrix which traps red cells in it; can occlude the whole lumen
  • white thrombi are not capable of blocking the whole lumen; can trap platelets in it
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10
Q

characteristics of a STEMI

A
  • ST elevation

- relatively higher troponin rises

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11
Q

treatment for STEMIs

A
  • fibrinolytic eg alteplase

- angioplasty

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12
Q

stable vs unstable angina

A
  • stable: simple mismatch of supply and demand; consistent symptoms in intensity
  • unstable: the unpredictable intensity of symptoms
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13
Q

symptoms of angina

A

chest pain, shortness of breath, sweating, fatigue, belching, nausea and vomiting

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14
Q

describe the chest pain

A

retrosternal, diffuse, discomfort-type, radiates to the jaw, neck, shoulder and arm

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15
Q

haemodynamic symptoms of angina

A

hypotension, low cardiac output, shock, pulmonary congestion, pulmonary oedema, heart failure

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16
Q

cause of death in angina

A

arrhythmias secondary to the ischaemia

17
Q

questions to ask when administering antithrombolytics

A
  • are you on thrombolytics already?
  • do you have: bleeding PR, bleeding tumour, haematuria
  • recent surgeries?
  • recent strokes?
  • have you used anticoagulants?
18
Q

contraindications of beta-blockers

A
  • obstructive pulmonary diseases eg asthma, COPD

- heart failure

19
Q

short-term complications of a myocardial infarction

A
  • arrhythmia
  • ventricular rupture
  • mitral regurgitation due to papillary muscle rupture
  • pulmonary oedema
  • low cardiac output
  • heart failure
  • pain (managed by opiates or heroin)
  • acquired septal defect (septal rupture)
  • ventricular aneurysm
20
Q

long-term complications of a myocardial infarction

A
  • arrhythmia due to the fibrosis (treat as a potential VT0

- Dressler’s (autoimmune pericarditis)

21
Q

treatment of MI

A
  • antiplatelets
  • anticoagulants
  • ACE inhibitors
  • beta blockers
  • statins
  • manage pre-existing comorbidities
  • lifestyle changes
22
Q

follow-up of MI

A
  • reinforce lifestyle changes

- monitor heart rhythm, BP, glucose, lipids to keep the other comorbidities in check

23
Q

ST changes in which leads?

A
  • inferior MI (RCA territory) - II, III, avF
  • anterior MI (LAD territory) - V1-V6
  • lateral MI (Cx territory) - avL, I, V5, V6
24
Q

differentials of a myocardial infarction

A
  • cardiac (aortic dissection; angina; myocarditis; Prinzmetal’s)
  • respiratory (pulmonary embolism; pneumothorax; pleuritic chest pain)
  • gastrointestinal (oesophageal reflux; oesophageal spasm, oesophagitis; oesophageal tumour)
25
Q

what are the types of coronary syndromes? list examples

A
  • acute: unstable angina; NSTEMI; STEMI

- chronic: stable angina

26
Q

ECG changes in STEMIs and NSTEMIs

A

STEMI: ST elevation; LBBB
NSTEMI: peaked T waves; inverted T waves; ST depression
further along: U waves

27
Q

Lab results in MI vs angina

A

Troponin rises only happen in MIs; ECG changes happen in both

28
Q

Chest X-ray changes in myocardial infarction

A
  • pulmonary oedema
  • widened mediastinum
  • cardiomegaly
29
Q

management of a myocardial infarction

A 
MONA
- Morphine
- Oxygen (if saturation is below 94%)
- Nitrates
- Aspirin
Add clopidogrel if this is a high-risk NSTEMI/STEMI
30
Q

Risk factors of ischaemic heart disease

A

Modifiable: obesity, dyslipidaemia, lack of exercise, hypertension, diabetes, smoking
Non-modifiable: age, gender

31
Q

Contraindications of fibrinolytic therapy

A
  • haemorrhagic strokes
  • ischaemic stroke
  • CNS trauma
  • recent trauma
  • recent surgery
  • GI bleeds
  • bleeding disorder
  • aortic dissection
  • pregnancy
  • oral anticoagulation therapy
  • advanced liver disease
  • refractory resuscitation
  • refractory hypertension
32
Q

characteristics of stable angina

A
  • compressive chest pain which radiates and shit
  • exacerbated on physical exertion and emotional stress
  • relieved by GTN and rest
33
Q

Angina Severity Classification

A

used from the ESC

  • Class I: brought on by very rigorous exercise eg triathlon, sports
  • Class II: brought on by medium-intensity activity eg walking up 3 flights of stairs, running
  • Class III: brought on by mild exercise eg normal going on 1 flight of stairs
  • Class IV: brought on by normal daily activity; may not be relieved by rest
34
Q

symptoms of unstable angina

A
  • prolonged intensity angina
  • can be present at rest
  • crescendo pattern
35
Q

Syndrome X

A

clinical presentation of angina; normal coronaries on angiography

36
Q

Prinzmetal’s angina

A

vasospasm of the coronary arteries in normal ones; can supersede severe coronary disease; can be present at rest

37
Q

Investigations in coronary artery disease

A
  • ECG
  • cardiac biomarkers
  • Exercise Stress Test
  • Stress Echocardiography
  • Echocardiography
  • Coronary Angiography (both invasive and noninvasive)
  • Holter test
38
Q

Indication for PCIs

A
  • long lesions
  • bifurcated lesions
  • multiple lesions
  • complete occlusions
  • small vessel lesions
39
Q

Indication for bypass surgery

A

triple vessel disease (affects LAD, LCx and RCA)

Medicine I: Cardiology (7 decks)

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