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Cardiology > Acute Coronary Syndrome > Flashcards

Acute Coronary Syndrome Flashcards

1
Q

What does Acute Coronary Syndrome encompass?

A

STEMI
NSTEMI
Unstable angina

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2
Q

What is ACS usually due to?

A

A thrombus from an atherosclerotic plaque blocking a coronary artery

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3
Q

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

A

Platelets

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4
Q

Why are antiplatelet medications used to treat ACS?

A

Thrombi are made up of mostly platelets

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5
Q

What are examples of anti-platelet medications?

A

Aspirin
Clopidogrel
Ticagrelor

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6
Q

How does ACS cause problems?

A

Reduces blood flow to the heart

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7
Q

What is reduced blood flow to the heart known as?

A

Myocardial ischaemia

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8
Q

What is a STEMI due to?

A

Complete occlusion of the coronary artery

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9
Q

What type of damage does a STEMI cause?

A

Irreversible damage

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10
Q

What are other names for a STEMI?

A

Transmural MI

Q Wave MI

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11
Q

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

A

ST elevation

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12
Q

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

A

Q waves

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13
Q

What does a STEMI cause?

A

Ongoing myocyte death

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14
Q

What is the criteria for diagnosis of a STEMI?

A

ST elevation

Or new left bundle branch block

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15
Q

What is the management of a STEMI?

A

Revascularisation within 12 hours

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16
Q

What are the 2 forms of revascularisation?

A

Primary Percutaneous Coronary Intervention

Thrombolysis

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17
Q

What is primary percutaneous coronary intervention?

A

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

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18
Q

What is thrombolysis?

A

Injecting a fibrinolytic medication that rapidly dissolves clots.

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19
Q

What is the risk associated with thrombolyisis?

A

The risk of bleeding

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20
Q

What type of intervention is primary percutaneous coronary intervention?

A

Diagnostic and theraputic

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21
Q

What is an NSTEMI?

A

Non-ST elevation MI

22
Q

What is the criteria for diagnosis of an NSTEMI?

A

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

23
Q

What other ECG changes would you get with an NSTEMI?

A

ST depression
T wave inversion
Pathological Q waves

24
Q

What is another name for an NSTEMI?

A

Non-transmural MI

25
Q

What does non-transmural mean?

A

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

26
Q

What type of damage does an NSTEMI cause?

A

Ischaemia

Reversible

27
Q

What is the criteria for diagnosis of Unstable angina?

A

Troponin levels are normal

The ECG does not show pathological changes

28
Q

What is a typical history of someone with unstable angina?

A 
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
29
Q

What will not be raised in unstable angina?

A

Troponin

30
Q

What are non-ACS causes of raised troponin?

A 
Chronic renal failure	
Sepsis	     
Myocarditis	
Aortic dissection       
Pulmonary embolism
31
Q

What investigations would you carry out?

A

Bloods
ECG
Echocardiogram
Chest x-ray

32
Q

What would you loo for in the blood?

A

Troponing T and I

Creatinine Kinase

33
Q

What does MONA stand for?

A

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

34
Q

Why and when would you do an Echocardiogram?

A

After the event

To check for functional damage

35
Q

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

A

Posterior lead

36
Q

Why would you do a chest x-ray?

A

To check for other causes of chest pain

36
Q

When would you test for troponin?

A

Baseline
6 hours
12 hours

38
Q

What is the pneumonic for the treatment of NSTEMI?

A

BATMAN

39
Q

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

A

MONA

40
Q

What does BATMAN stand for?

A

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

41
Q

What is the pneumonic for complications of an MI?

A

DREAD

42
Q

What does DREAD stand for?

A 
D – Death
R – Rupture of the heart septum or papillary muscles
E – “Edema” (Heart Failure)
A – Arrhythmia and Aneurysm
D – Dressler’s Syndrome
43
Q

What is Dressler’s syndrome?

A

Post-myocardial infarction syndrome.

44
Q

When does Dressler’s syndrome usually occur?

A

2-3 weeks post MI

45
Q

What causes Dressler’s syndrome?

A

Localised immune response resulting in Pericarditis

46
Q

How does Dressler’s syndrome present?

A

Pleuritic chest pain
Low grade fever
Pericardial rub on auscultation

47
Q

How is Dressler’s syndrome diagnosed?

A

ECG
Echocardiogram
Raised inflammatory markers

48
Q

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

A

Global ST elevation

T wave inversion

49
Q

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

A

Pericardial effusion

50
Q

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

A

ESR

CRP

51
Q

What is the management of Dressler’s syndrome?

A

NSAIDs- Aspirin / ibuprofen

Severe cases steroids- Prednisolone

Cardiology (66 decks)

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