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Cardiology Y1 > Acute Coronary Syndrome > Flashcards

Acute Coronary Syndrome Flashcards

1
Q

what is the usual cause of ACS

A

thrombus from an atherosclerotic plaque blocking a coronary artery

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2
Q

when a thrombus is formed in a fast flowing artery what is it mostly made up of

A

platelets

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3
Q

in what case is a thrombus mostly made up of platelets

A

when formed in a fast flowing artery

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4
Q

what type of medication is the main treatment for ACS

A

anti platelet medication

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5
Q

give 3 examples of anti platelet medication

A
  • aspirin
  • clopidogrel
  • ticagrelor
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6
Q

which artery is most commonly affected by ACS as a result of a thrombus

A

Left anterior descending

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7
Q

what 2 vessels branch off the left coronary artery

A
  • circumflex

- left anterior descending

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8
Q

what areas (4) of the heart are supplied by the right coronary artery

A
  • right atrium
  • right ventricle
  • inferior aspect of left ventricle
  • posterior septal area
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9
Q

what areas of the heart (2) does the circumflex artery supply

A
  • left atrium

- posterior aspect of left ventricle

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10
Q

what areas of the heart (2) does the left anterior descending artery supply

A
  • anterior aspect of left ventricle

- anterior aspect of septum

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11
Q

name the 3 types of ACS

A
  • unstable angina
  • STEMI
  • NSTEMI
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12
Q

what is the first step when a patient presents w/ ACS symptoms

A

perform ECG

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13
Q

how is STEMI diagnosed (2)

A
  • ST elevation on ECG

- new left bundle branch block

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14
Q

what is the next step if no ST elevation is shown on the ECG

A

perform troponin blood tests

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15
Q

how is NSTEMI diagnosed (2-4)

A 
- raised troponin levels 
and/or 
- other ECG changes
--> ST depression 
--> T wave inversion 
--> pathological Q waves
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16
Q

diagnosis if troponin levels are normal and no pathological changes shown on ECG

A

unstable angina

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17
Q

differential diagnosis if troponin levels are normal and no pathological changes shown on ECG

A

musculoskeletal chest pain

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18
Q

what is the main symptom of ACS

A

central constricting chest pain

19
Q

what other ACS symptoms can be assc. w/ chest pain (6)

A
  • nausea and vomiting
  • sweating and clamminess
  • feeling of impending doom
  • SoB
  • palpitations
  • pain radiating to jaw or arms
20
Q

where might chest pain radiate to in ACS (2)

A
  • jaw

- arms

21
Q

changes in what ECG leads would indicate pathology in LCA (3)

A
  • i
  • aVL
  • V3-6
22
Q

changes in what ECG leads would indicate pathology in LAD artery

A
  • V1-4
23
Q

changes in what ECG leads would indicate pathology in circumflex artery (3)

A
  • i
  • aVL
  • V5-6
24
Q

changes in what ECG leads would indicate pathology in RCA

A
  • ii
  • iii
  • aVF
25
Q

what are troponins

A

proteins found in cardiac muscle

26
Q

presence of what SPECIFIC troponins is used for diagnosis of ACS

A

serial troponins

27
Q

what is the time period of measuring troponins (2)

A
  • baseline

- 6 or 12 hours after onset of symptoms

28
Q

what pathological condition is a rise in troponin levels consistent with and why (2)

A
  • myocardial ischaemia

- troponin released from ischaemic muscle

29
Q

what does it mean that troponins are non-specific

A

raised troponin doesn’t automatically mean ACS

30
Q

give some alternative causes of raised troponins (5)

A
  • chronic renal failure
  • sepsis
  • myocarditis
  • aortic dissection
  • pulmonary embolism
31
Q

what other investigations might you perform when investigating Px presenting w/ ACS (8)

A
  • physical exam
  • ECG
  • FBC
  • U&E
  • LFTs
  • Lipid profile
  • Thyroid function test
  • HbA1c and fasting glucose
32
Q

what radiographic investigations might you do for Px presenting w/ ACS (3) and why (3)

A
  • chest Xray
  • -> other causes of chest pain and pulmonary oedema
  • echocardiogram
  • -> after event to assess functional damage
  • CT coronary angiogram
  • -> assess for coronary artery disease
33
Q

what is the treatment for acute STEMI (2) and the time period of treatment (2)

A
  • primary PCI
  • -> if available within 2hrs of presentation
  • thrombolysis
  • -> if PCI not available within 2hrs
34
Q

describe Percutaneous Coronary Intervention (PCI)

A

catheter inserted into Px brachial/femoral artery, fed up to coronary arteries under X-ray guidance, contrast injected and used to identify area of blockage, balloon used to widen gap, stent put in place to keep artery open

35
Q

describe thrombolysis treatment

A

fibrinolytic medication injected to breakdown fibrin and rapidly dissolve clots

36
Q

what is the risk with thrombolysis treatment

A

significant risk of bleeding

37
Q

give examples of thrombolytic agents (3)

A
  • streptokinase
  • alteplase
  • tenecteplase
38
Q

list the treatment options for acute NSTEMI (6)

A

BATMAN

B - beta blockers
A - aspirin 300mg stat dose
T - ticagrelor 180mg stat dose (clopidogrel if ^ bleeding risk)
M - morphine (pain control)
A - anticoagulant (unless ^ bleeding risk)
N - nitrates (GTN) (relieve coronary spasm)

39
Q

what is the GRACE score

A

scoring system that gives 6 month risk of death/ repeat MI after having an NSTEMI

40
Q

what are the 3 limits in GRACE score and what limits would Px be considered for PCI

A
  • <5% low risk
  • 5-10% med risk
  • > 10% high risk

med and high risk considered for early PCI

41
Q

give the complications of MI (5)

A

DREAD

D - death 
R - rupture of heart septum or papillary muscles 
E - 'edema' (heart failure) 
A - arrhythmia and aneurysm 
D - Dressler's syndrome
42
Q

what is Dressler’s syndrome (post-myocardial infarction syndrome), how does it present (3), what can it cause (2), how is it diagnosed (3), and how is it managed (3)

A
  • localised immune response that causes pericarditis

symptoms

  • pleuritic chest pain
  • low grade fever
  • pericardial rub on auscultation

causes

  • pericardial effusion
  • pericardial tamponade

diagnosis

  • ECG (global ST ^ and T wave inversion)
  • echocardiogram (pericardial effusion)
  • ^ inflammatory markers (CRP and ESR)

Managed

  • NSAIDs
  • steroids (severe) (prednisolone)
  • pericardiocentesis (remove fluid)
43
Q

outline secondary prevention medical management (6)

A

6As

  • Aspirin (75mg x1 a day)
  • Another antiplatelet
  • Atorvastatin (80mg x1 a day)
  • ACEi
  • Atenolol
  • Aldosterone antagonists (Px w/ clinical heart failure)
44
Q

outline secondary prevention lifestyle changes (5)

A
  • stop smoking
  • reduce alcohol consumption
  • mediterranean diet
  • cardiac rehabilitation
  • optimise treatment of other medical conditions

Cardiology Y1 (12 decks)

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