Acute Coronary Syndrome

Question 1

What does Acute Coronary Syndrome encompass?

Answer 1

STEMI
NSTEMI
Unstable angina

Question 2

What is ACS usually due to?

Answer 2

A thrombus from an atherosclerotic plaque blocking a coronary artery

Question 3

What is a thrombus usually made up of in an artery?

Answer 3

Platelets

Question 4

Why are antiplatelet medications used to treat ACS?

Answer 4

Thrombi are made up of mostly platelets

Question 5

What are examples of anti-platelet medications?

Answer 5

Aspirin
Clopidogrel
Ticagrelor

Question 6

How does ACS cause problems?

Answer 6

Reduces blood flow to the heart

Question 7

What is reduced blood flow to the heart known as?

Answer 7

Myocardial ischaemia

Question 8

What is a STEMI due to?

Answer 8

Complete occlusion of the coronary artery

Question 9

What type of damage does a STEMI cause?

Answer 9

Irreversible damage

Question 10

What are other names for a STEMI?

Answer 10

Transmural MI

Q Wave MI

Question 11

What is seen initially on an ECG of someone with a STEMI?

Answer 11

ST elevation

Question 12

What is seen on an ECG 3 days after someone has had a STEMI?

Answer 12

Q waves

Question 13

What does a STEMI cause?

Answer 13

Ongoing myocyte death

Question 14

What is the criteria for diagnosis of a STEMI?

Answer 14

ST elevation

Or new left bundle branch block

Question 15

What is the management of a STEMI?

Answer 15

Revascularisation within 12 hours

Question 16

What are the 2 forms of revascularisation?

Answer 16

Primary Percutaneous Coronary Intervention

Thrombolysis

Question 17

What is primary percutaneous coronary intervention?

Answer 17

Putting a catheter into the patient’s brachial or femoral artery under xray guidance and injecting contrast to identify the area of blockage

Then put a balloon or device to widen gap

Question 18

What is thrombolysis?

Answer 18

Injecting a fibrinolytic medication that rapidly dissolves clots.

Question 19

What is the risk associated with thrombolyisis?

Answer 19

The risk of bleeding

Question 20

What type of intervention is primary percutaneous coronary intervention?

Answer 20

Diagnostic and theraputic

Question 21

What is an NSTEMI?

Answer 21

Non-ST elevation MI

Question 22

What is the criteria for diagnosis of an NSTEMI?

Answer 22

No ST elevation
Raised troponin levels
And/or other ECG changes

Question 23

What other ECG changes would you get with an NSTEMI?

Answer 23

ST depression
T wave inversion
Pathological Q waves

Question 24

What is another name for an NSTEMI?

Answer 24

Non-transmural MI

Question 25

What does non-transmural mean?

Answer 25

MI that does not cause necrosis through the full thickness of the myocardium

Question 26

What type of damage does an NSTEMI cause?

Answer 26

Ischaemia | Reversible

Question 27

What is the criteria for diagnosis of Unstable angina?

Answer 27

Troponin levels are normal | The ECG does not show pathological changes

Question 28

What is a typical history of someone with unstable angina?

Answer 28

``` Convincing anginal symptoms Rapidly worsening (crescendo history) May now be occurring at rest ECG may be normal NO cell death so troponins will NOT be raised ```

Question 29

What will not be raised in unstable angina?

Answer 29

Troponin

Question 30

What are non-ACS causes of raised troponin?

Answer 30

``` Chronic renal failure Sepsis Myocarditis Aortic dissection Pulmonary embolism ```

Question 31

What investigations would you carry out?

Answer 31

Bloods ECG Echocardiogram Chest x-ray

Question 32

What would you loo for in the blood?

Answer 32

Troponing T and I | Creatinine Kinase

Question 33

What does MONA stand for?

Answer 33

o Morphine o Oxygen if <94% o Nitrates- GTN o Aspirin- 300 mg Aspirin ASAP unless allergic – then clopidogrel

Question 34

Why and when would you do an Echocardiogram?

Answer 34

After the event | To check for functional damage

Question 35

What is used to ensure that you don't miss a STEMI with an ECG?

Answer 35

Posterior lead

Question 36

Why would you do a chest x-ray?

Answer 36

To check for other causes of chest pain

Question 36

When would you test for troponin?

Answer 36

Baseline 6 hours 12 hours

Question 38

What is the pneumonic for the treatment of NSTEMI?

Answer 38

BATMAN

Question 39

What is the pneumonic for the initial management of all ACS?

Answer 39

MONA

Question 40

What does BATMAN stand for?

Answer 40

B – Beta blockers A – Aspirin 300mg T – Ticagrelor 180mg (clopidogrel 300mg alternative) M – Morphine to control pain A – Anticoagulant: (LMWH) e.g. enoxaparin 1mg/kg twice daily for 2-8 days N – Nitrates (e.g. GTN) to relieve coronary artery spasm

Question 41

What is the pneumonic for complications of an MI?

Answer 41

DREAD

Question 42

What does DREAD stand for?

Answer 42

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

Question 43

What is Dressler's syndrome?

Answer 43

Post-myocardial infarction syndrome.

Question 44

When does Dressler's syndrome usually occur?

Answer 44

2-3 weeks post MI

Question 45

What causes Dressler's syndrome?

Answer 45

Localised immune response resulting in Pericarditis

Question 46

How does Dressler's syndrome present?

Answer 46

Pleuritic chest pain Low grade fever Pericardial rub on auscultation

Question 47

How is Dressler's syndrome diagnosed?

Answer 47

ECG Echocardiogram Raised inflammatory markers

Question 48

What would you find on an ECG of someone with Dressler's syndrome?

Answer 48

Global ST elevation | T wave inversion

Question 49

What would you find on an Echocardiogram of someone with Dressler's syndrome?

Answer 49

Pericardial effusion

Question 50

Which inflammatory markers would be raised in Dressler's syndrome?

Answer 50

ESR | CRP

Question 51

What is the management of Dressler's syndrome?

Answer 51

NSAIDs- Aspirin / ibuprofen | Severe cases steroids- Prednisolone