acute coronary syndrome

Question 1

what is a myocardial infarction ?

Answer 1

complete cessation of coronary perfusion

Question 2

what are the causes of myocardial infarction ?

Answer 2

• atherosclerosis
• ruptured athermatous plaque with superimposed thrombus
• aortic stenosis
• aortic dissection

Question 3

what are the risk factors of MI ?

Answer 3

non modifiable risk factors:
age 
sex
family history 
modifiable:
hypertension 
dyslipidemia 
smoking 
DM 
obesity

Question 4

what is the clinical presentation ?

Answer 4

chest pain 
anxiety 
sympathetic stimulation 
vagal stimulation 
hypotension 
symptoms of complications

Question 5

what are the pathological types of myocardial infarctions ?

Answer 5

transmural

sub-endocardial

Question 6

what is the universal classification of MI?

Answer 6

MI type 1

MI type 2

Question 7

what is the pathology in type 1 MI ?

Answer 7

plaque rupture with thrombus

Question 8

what is the pathology in type 2 MI ?

Answer 8

• vasospasm or endothelial dysfunction
• fixed atherosclerosis and supply-demand imbalance
• supply-demand imbalance alone
• sepsis
• hypo perfusion

Question 9

if there is an anterior wall infarction where is the occlusion ?

Answer 9

anterior descending branch

Question 10

if there is a lateral wall infarction where is the occlusion ?

Answer 10

occlusion in left circumflex artery

Question 11

if there is an inferior wall infarction where is the occlusion ?

Answer 11

occlusion in the right coronary artery

Question 12

what are the investigations for MI ?

Answer 12

ECG
cardiac biomarkers Troponin
coronary angiography

Question 13

what is the treatment for MI ?

Answer 13

angioplasty

Question 14

what are the complications of MI ?

Answer 14

left ventricular failure 
ruptured papillary muscle 
ruptured interventricular septum 
extension of infarction 
mural thrombus 
arrythmia

Question 15

what are the complications of cardiac tamponade ?

Answer 15

pulmonary edema
shock
death

Question 16

what are the late complicatios of MI ?

Answer 16

myocardial aneurysms

pericarditis (dressler’s syndrome)

Question 17

what is dresslers syndrome ?

Answer 17

post MI pericarditis

Question 18

what are the different types of ACS ?

Answer 18

unstable angina
NSTEMI
STEMI

Question 19

what are the troponin test results associated with each type of ACS ?

Answer 19

unstable angina - troponin negative chest pain
NSTEMI - troponin positive chest pain but with no ST elevation , but probably has ST depression or inverted T wave
STEMI - Troponin positive chest pain with ST elevation

Question 20

what is the difference between stable and unstable angina ?

Answer 20

both are troponin negative chest pains
but stable angina is chest pain on exertion
unstable angina is chest pain at rest

Question 21

late complication of MI ?

Answer 21

1- myocardial aneurysm and remodelling
2- Dressler syndrome

Question 22

what is the treatment for pericarditis ?

Answer 22

NSAIDs and colchicine and morphine

Question 23

what are the rules that must be followed when taking troponin samples ?

Answer 23

taken 3 hours after onset of chest pain
repeated again after 6 hours

Question 24

what is the management of STEMI ?

Answer 24

1- give oxygen therapy
2- then a loading dose off aspirin 300mg
along with clopidogrel
morphine for pain relief
3- spray GTN or nitrates for symptomatic relief
4- PPCI

initial therapy ( MONA )

Question 25

what is the management for NSTEMI ?

Answer 25

same initial treatment as STEMI ( MONA )
but give antithrombin treatment - heparin
before performing the angiogram

Question 26

what drugs should be taken post MI ?

Answer 26

1- Aspirin 75mg OM + second anti-platelet (clopidogrel)
2- Beta blocker (normally bisoprolol)
3- ACE-inhibitor (normally ramipril)
4- High dose statin (e.g. Atorvastatin 80mg ON)

Question 27

what is the management for dresslerrs syndrome ?

Answer 27

high dose aspirin