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Week 5 - Cardiology > Acute Coronary Syndrome > Flashcards

Acute Coronary Syndrome Flashcards

1
Q

What are the symptoms of myocardial infarction

A
  • Chest pain
  • Back pain
  • Jaw pain
  • Indigestion
  • Sweatiness, clamminess
  • Shortness of breath
  • May have no symptoms
  • Death
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2
Q

What are the signs of myocardial infarction?

A
  • Tachycardia
  • Distressed patient
  • Heart failure
  • Shock (cardiogenic)
  • Arrhythmia
  • None
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3
Q

What are the investigations for acute myocardial infarction?

A
  • ECG - evidence of ST segment deviation
  • Bloods - cardiac troponin
  • Chest X ray and Echocardiogram to look for evidence of acute heart failure/left ventricular systolic dysfunction
  • Coronary angiogram: coronary artery anatomy
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4
Q

What is troponin?

A
  • Integral part of the myocyte
  • 3 types: Tn1, TnT, TnC
  • Release into blood stream and is a maker of myocyte necrosis
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5
Q

What causes an increase in troponin?

A 
In order from largest increase to low
•STEMI 
•NSTEMI 
•Myocarditis 
•Marathon 
•PE (right ventricle struggling)
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6
Q

What is the universal definition of MI?

A

•Any elevation in troponin in clinical setting consistent with myocardial ischaemia

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7
Q

type 1 MI

A

Spontaneous MI due to a primary coronary event (coronary artery plaque rupture and formation of thrombus

i.e. coronary artery is the problem

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8
Q

Type 2 MI

A 
Increased oxygen demand or reduced oxygen supply 
•Heart failure 
•Sepsis 
•Arrhythmia 
•Hyper or hypotension

i.e. coronary artery is not the problem

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9
Q

Type 3 MI

A

Sudden cardiac death

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10
Q

Type 4a MI

A

MI associated with percutaneous coronary intervention

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11
Q

Type 4b

A

MI stent thrombosis documented by angiography or PM

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12
Q

Type 5 MI

A

MI associated with CABG

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13
Q

What will patients with a type 1 MI always have that those with a type 2 MI may or may not have?

A

Atherosclerosis

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14
Q

Drugs immediately given for STEMI

A
  • Aspirin - 300mg
  • Ticagrelor - 180mg
  • IV heparin -5000u (if not already anti coagulated)
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15
Q

Drugs given immediately for ACS (NSTEMI)

A

Aspirin - 300mg

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16
Q

What is the name of the score for chest pain patients

A

HEART

17
Q

Explain the HEART score

A

•History

  • highly suspicious - 2
  • moderately - 1
  • slightly - 0

•ECG

  • Significant ST deviation - 2
  • Non specific repolarisation disturbance/LBBB/PM - 1
  • Normal - 0

•Age

  • ≥65 - 2
  • 45-65 - 1
  • ≤45 - 0

•Risk factors

  • ≥ 3 or atherosclerotic disease - 2
  • 1 or 2
  • none known - 0

•Troponin

  • ≥3 times normal limit - 2
  • ≥ 1-3 times normal limit
18
Q

According to the HEART score what are the risk factors of atherosclerotic disease?

A
  • Hypertension
  • hypercholesterolaemia
  • Diabetes mellitus
  • Cigarette smoking
  • Positive family history
  • Obesity (BMI > 30)
19
Q

What are the proposed policies based on the HEART scores?

A
  • 0-3 = discharge
  • 4-6 = observation and risk management
  • 7-10 = observation, treatment, CAG
20
Q

Management of ACS once confirmed troponin ≥16ng/L in women or >34 for men

A
  • Full medical review: bloods, ECG, Chest X ray
  • Consider other causes of raised troponin (PTE, LVF, arrhythmia, sepsis)
  • Ensure not on any anticoagulants
  • Ticagrelor 180mg then 90mg
  • Fondapaeinux 2.5mg subcut
  • PRN sublingual GTN spray
21
Q

What are the non coronary causes of elevated troponin?

A 
Causes of Type 2 MI: 
•Sepsis 
•Congestive heart failure (acute) 
•Tahcy-arrhythmia 
•Pulmonary embolism 
•Apical ballooning syndrome 
•Anything that stresses the heart i.e. critically unwell patient

Chronic elevation of troponin:
•Renal failure
•Chronic heart failure
•Infiltrative cardiomyopathies e.g. sarcoidosis, amyloidosis, haemochromatosis

22
Q

What is unstable angina?

A

An acute coronary event without a rise in troponin

23
Q

Explain glagovian remodelling

A
  • Normal vessel
  • Minimal CAD - atheroma starts to form in wall but lumen is maintained due to compesnsatory expansion
  • Advanced CAD - expansion limit and lumen narrows
24
Q

What does ST elevation represent?

A

Occlusion of a coronary artery

25
Q

In which location of a STEMI would you not be able to see ST elevation?

A

Posterior

26
Q

What can obscure ST elevation on a ECG?

A

An old left bundle branch block

27
Q

Which arteries are affected in an inferior infarction?

A
  • Mostly Right Coronary Artery

* Or left circumflex

28
Q

Which arteries are responsible for a posterior infarct?

A
  • Mostly circumflex

* Can be Right coronary artery

29
Q

Which arteries are responsible for lateral infarct?

A

Left circumflex

30
Q

Which arteries are repsonsible for an anteroseptal infarct?

A

Left anterior descending

31
Q

What are the anterior ECG leads?

A

V1- V3

32
Q

What are the inferior ECG leads?

A

2, 3, avF

33
Q

What are the Lateral ECG leads?

A

V5, V6

34
Q

What are the septal leads?

A

V3, V4

35
Q

What would a posterior STEMI look like on ECG?

A
  • Anterior lead ST depression - V1-V3

* May see inferior or lateral ST elevation

36
Q

What is the immediate management of a STEMI?

A 
•ABC 
•Put in ambulance attached to defibrillator
•Aspirin 300mg PO
•Unfractionated heparin 5000u IV 
•Morphine 
•Anti-emetics 
•Clopidogrel 
 - 600mg if PPCI 
 - 300mg if for thrombolysis (75mg if >75) 
•Ticagrelor 
•Activate PPCI team
37
Q

What is the subsequent management for MI?

A
  • Monitor in coronary care unity for complications
  • Drugs for secondary prevention
  • Echocardiogram
  • Cardiac rehabilitation
  • if LVSD at >9 months, consider primary prevention ICD
38
Q

What are the drugs for secondary prevention of MI?

A
  • ACEi
  • Beta blockers
  • Statins
  • Epelerone - only for diabetes and LVSD or clinical HF
39
Q

What are the complications of MI?

A
  • Arrhythmia
  • Heart failure
  • Cardiogenic shock
  • Myocardial rupture
  • Psychological: anxiety/depression

Week 5 - Cardiology (8 decks)

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