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Medicine year 1 > Acute coronary disease > Flashcards

Acute coronary disease Flashcards

1
Q

What is acute coronary syndrome

A

Any acute presentation of coronary artery disease

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2
Q

What are the characteristics of acute coronary syndrome (4)

A

dynamic stenosis
Supply-led ischaemia
Unpredictable
Dangerous

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3
Q

What is the pathogenesis of acute coronary syndrome (3)

A

plaque ruptures
Clot forms
Vessel is either partially or totally occluded

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4
Q

What factors can affect plaque rupture (6)

A

lipid content
Thickness of fibrous cap
Intraluminal pressure changes
Bending/twisting of artery
Shape
Mechanical injury

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5
Q

What can total vessel occlusion lead to

A

ST elevation MI

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6
Q

What can subtotal vessel occlusion lead to

A

Non-ST elevation MI

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7
Q

What are the three steps of the platelet cascade

A

Adhesion
Activation
Aggregation

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8
Q

How are platelets activated (4)

A

when platelets are exposed to a vascular injury, they release ADP and switch on cycloxygenase
Cycloxygenase generates thromboxane A2
ADP and thromboxane A2 bind to receptors on the surface of platelets
This activates the platelets

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9
Q

Other than platelets, what can be incorporated into a clot (3)

A

Fibrin
White blood cells
Red blood cells

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10
Q

What is the pain caused by STEMI like (5)

A

severe
Radiating
Crushing
Prolonged
Not relieved by GTN

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11
Q

What symptoms other than pain are associated with STEMI

A

sweating
Nausea
Vomiting

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12
Q

What must be observed on an ECG for diagnosis as a STEMI (2)

A

an elevation of more than 1mm in two adjacent limb leads
Or
An elevation of more than 2mm in two contiguous precocial leads

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13
Q

What other abnormal features can be observed on an ECG due to a STEMI (3)

A

New onset bundle branch block
T wave inversion
A waves

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14
Q

What mechanisms can be used to manage STEMIs (2)

A

preventing platelet activation
Fibrinolysis

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15
Q

What drugs can be used to prevent platelet activation in STEMI

A

P2Y12 receptor antagonists (clopidogrel blocks ADP receptors on platelets)
Aspirin (inhibits cycloxygenase system)

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16
Q

What are the risks of using thrombolytic drugs to manage STEMIs (3)

A

Failure to re-perfuse
Haemorrhage
Hypersensitivity

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17
Q

What does reperfusion therapy include (2)

A

thrombolytic drugs
Percutaneous coronary intervention

18
Q

What are the indications for reperfusion therapy (2)

A

Chest pain that suggests acute myocardial infarction
ECG changes

19
Q

What are the contraindications of reperfusion therapy (6)

A

bleeding disorder
stroke
CNS damage/neoplasm
Internal bleeding
Aortic dissection
Trauma/surgery

20
Q

What increases long-term mortality (in relation to management of STEMIs)

A

failed thrombolysis

21
Q

When is thrombolysis used to treat STEMIs

A

If angioplasty is not available within 120 minutes

22
Q

What complications can arise from acute myocardial infarction (4)

A

death
Arrhythmic complications
Structural complications
Functional complications

23
Q

What are examples of structural complications arising from acute myocardia infarction (2)

A

Cardiac rupture
Ventricular septal defect
Mitral valve regurgitation

24
Q

What observations are taken for an acute myocardial infarction (7)

A

pulse
Bp
Patient feeling
Heart sounds
Murmurs
Pulmonary crepitations
Fluid balance

25
Q

What can be used to diagnose an NSTEMI

A

bio markers - troponin complex

26
Q

Describe the troponin complex (3)

A

Globular protein complex
Found in thin myofilaments
Regulates muscle contraction

27
Q

How are NSTEMIs managed (2)

A

stent
Dual-anti-platelet therapy

28
Q

Which drug is preferred as the first agent in treatment of NSTEMIs

A

Clopidogrel

29
Q

Describe characteristics of unstable angina (3)

A

symptoms suggestive of MI
No troponin I release
Usually no ECG changes

30
Q

What is type one myocardial infarction

A

ischaemia due to a primary coronary event

31
Q

What are the characteristics of type one MI (3)

A

major ECG changes
Higher troponin
Severe coronary artery disease

32
Q

What is type two MI

A

secondary
Ischaemia due to imbalance of oxygen supply and demand

33
Q

What can cause type two MI (2)

A

coronary embolism
Hypertension

34
Q

What can cause type one MI

A

plaque rupture

35
Q

What are the characteristics of type 2 MI (5)

A

less severe chest pain
Minor ECG changes
Mild-moderate coronary disease
Tachycardia
Low blood pressure

36
Q

What is type three MI

A

sudden cardiac death with symptoms suggestive of ischaemia

37
Q

What is controlled in secondary prevention of acute coronary syndrome (3)

A

blood pressure
Cholesterol
Diabetes

38
Q

What are the four phase of cardiac rehabilitation

A

in-patient care
Early post-discharge period
Structured exercise program
Long term maintenance of physical activity and lifestyle changes

39
Q

What are the target cholesterol levels in cardiac rehabilitation (2)

A

total < 4.0 mmol/l
HDL . 1.0 mmol/l

40
Q
A

Medicine year 1 (10 decks)

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