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Z Year3 Cardio Conditions > Acute Coronary Syndrome > Flashcards

Acute Coronary Syndrome Flashcards

1
Q

What is ischamic heart disease?

A

decreased blood supply to the heart muscle resulting in chest pain

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2
Q

What does ischaemic heart disease include?

A

stable angina + ACS

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3
Q

What is stable angina also called?

A

angina pectoris

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4
Q

What are RF for stable angina

A
  1. Smoking
  2. Hypertension
  3. Hyperlipidaemia
  4. isolated low HDL cholesterol
  5. diabetes
  6. inactivity
  7. obesity
  8. family history of coronary heart disease
  9. male sex
  10. illicit drug use
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5
Q

What are causes of stable angina?

A
  1. Thyroid disease
  2. Anaemia
  3. Hyperviscosity syndrome
  4. Arteriovenous fistula
  5. Underlying lung disease
  6. known exacerbating factors
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6
Q

How is angina graded?

A

I-IV

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7
Q

When does angina happen?

A

when narrowed arteries prevent blood that needs to get to the heart from getting there

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8
Q

What are typical angina symptoms?

A

1) chest pressure or squeezing lasting several minutes
2) provoked by exercise or emotional stress
3) relieved by rest or glyceryl trinitrate

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9
Q

What is atypical angina?

A

as chest discomfort with only two characteristics of typical angina: MORE typical if diabetes, women or older people

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10
Q

What is examination like in chonic stable angina?

A

normal

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11
Q

What are complications of stable angina?

A
  1. Ischaemic cardiomyopathy/heart failure
  2. Myocardial infarction
  3. Sudden cardiac death
  4. Stroke
  5. Peripheral arterial disease
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12
Q

What tests are done for stable angina?

A
  1. Resting ECG
  2. Cardio biomarkers
  3. Haemoglobin
  4. Lipid profile
  5. Fasting blood glucose or HbA1c
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13
Q

What is a resting ECG in stable angina

A

normal

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14
Q

What is a pathological Q wave? What do they indicate?

A
  • More than 40ms wide and more than 2mm deep

- Q waves indicate prior infarction

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15
Q

What is the management for stable angina?

A
  1. Educate
  2. Antiplatelet (aspirin, clopidogrel OD)
  3. Statin
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16
Q

What do you add to management if anginal symdtoms?

A

sublingual glyceryl trinitrate + CCB/beta blocker

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17
Q

What are RF for unstable angina?

A
  1. Diabetes
  2. Hyperlipidaemia
  3. Hypertension
  4. Metabolic syndrome
  5. Renal impairment
  6. Peripheral arterial disease
  7. A history of ischaemic heart disease and any previous treatment
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18
Q

What are symptoms and signs of unstable angina?

A
  1. prolonged angina at rest >20mins
  2. new onset of severe angina
  3. angina increasing in frequency or longer in duration or angina after recent episode of MI
    - Comes on randomly
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19
Q

When do you know if chest pain is cardiac?

A

retrosternal sensation of pain, pressure, or heaviness radiating to the left arm, both arms, right arm, neck, or jaw, which may be intermittent or persistent

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20
Q

What imaging is done and why in unstable angina?

A
  1. ECG: rule out NSTEMInormal
  2. Chest Xray: exclude other causes of chest pain e.g. pneumothorax
  3. ECHO: no new regional wall motion abnormalities
21
Q

What bloods are done and why in unstable angina?

A
  1. Cardiac Biomarkers: absent (no elevation in creatine kinase-MB or troponin) within 60mins
  2. FBC: normal, thrombocytopenia (To assess thrombocytopenia for bleeding risk for treatment), anaemia
  3. LFTS: baseline
  4. Blood glucose: normal or hyperglycaemia
  5. CRP: elevated of infection
  6. Us + Es + Cs: baseline
22
Q

What is first line management of unstable angina?

A
  1. Aspirin 300mg (continue indefinetly
  2. Fonaparinux (antithrombin)
    - GRACE
23
Q

What do you do if low risk Grace unstable angina?

A
  1. Ticagrelor + aspirin

2. If bleeding risk, aspirin ± clopidogrel

24
Q

What do you do if high risk Grace unstable angina?

A
  1. Angiography if unstable Angiography ± follow up PCI if indicated
  2. Ticagrelor + aspirin
  3. If PCI, offer prasugrel instead
25
Q

What is GRACE score?

A

Low risk = 6 month mortality ≤ 3%

Intermediate / higher risk = 6 month mortality > 3%

26
Q

What are complications for STEMI acronym?

A

DARTH VADAR

27
Q

What are complications of STEMI?

A
  1. Death
  2. Arrhythmia
  3. Rupture (free ventricular wall, septum, papillary
  4. Tamponade
  5. Heart fdailure
  6. Vavlulasr disease
  7. Aneurysm (ventricular)
  8. Dressler’s syndrome
  9. Embolism
  10. Recurrence
28
Q

What investigations are done for STEMI?

A
  1. ECG
  2. Coronary angiogrpahy: if more than 12hrs or specialist advice
  3. Troponin
  4. FBC
  5. CXR
29
Q

What are ECG changes on STEMI?

A
  1. First – hyperacute T waves
  2. ST depression
  3. ST elevation is dependent on the artery affected
  4. New onset LBBB
30
Q

What is the immediate management of STEMI?

A

300mg aspirin and continue indefinitely

31
Q

What is medical treatment of STEMI if symptoms >12h?

A
  1. Low risk: Ticagrelor + aspirin

2. High risk: clopidogrel + aspirin

32
Q

What is management of STEMI if Symptoms <12h and PCI possible in 2h?

A
  1. Angiography and PCI
  2. If they are taking anticoagulants: Clopidogrel + aspirin
  3. If not taking anticaogulants: prasugrel + aspirin
33
Q

What is management of STEMI if Symptoms<12h and PCI not possible in 2h?

A
  1. Fibrinolysis: alteplase + antithrombin
  2. If low risk bleeding Ticagrelor + aspirin
  3. If high risk, clopidogrel + aspirin
34
Q

When do you offer additional ECG?

A
  • 60-90 mins after drugs

- ST elevation persists angio and PCI if inficated

35
Q

What happens in a NSTEMI?

A

Partial or near complete occlusion of coronary artery

36
Q

What are symptoms of a NSTEMI in males?

A
  1. Chest pressure lasting several mins
  2. Sweating
  3. Dyspnoea
  4. Nausea
37
Q

What are symptoms of a NSTEMI in females?

A
  1. Middle/upper back pain or dyspnoea

2. SOB sweating

38
Q

What investigations are done for NSTEMI?

A
  1. Resting ECG
  2. Cardiac biomarkers
  3. CXR
39
Q

What are ECG changes in NSTEMI?

A

ST depression and T wave inversion

40
Q

What are cardiac biomarkers in NSTEMI?

A

: elevated at presentation or after several hours of troponin

41
Q

What bloods are done for STEMI?

A
  1. FBC: normal or possible anaemia and thrombocytopenia
  2. U+Es+Creatine
  3. LFTs
  4. Blood glucose
  5. CRP: elevated if infection
42
Q

What is 1st line treatment for NSTEMI?

A
  • 300mg aspirin dose & continue indefinitely

- Fondaparinux (antithrombin)

43
Q

What do you add if GRACE is low risk?

A
  1. Ticagrelor + aspirin

2. If bleeding risk, aspirin ± clopidogrel

44
Q

What do you add if GRACE is high risk?

A

Angiography if unstable Angiography ± followup PCI if indicated (72h)
Ticagrelor + aspirin
If PCI, offer prasugrel instead

45
Q

What does bleeding risk mean?

A

low platelets

46
Q

What does raised troponin mean?

A

myocardial ischaemia

47
Q

What are symptoms of STEMI?

A
  1. Severe chest pain
  2. Sweating
  3. SOB
  4. Pallor
  5. Jaw, arm
48
Q

When can STEMI be silent?

A

diabetics and elderly

49
Q

What do you add to management of STEMI if Symptoms <12h and PCI possible in 2h?

A

UFH, GIpIIb/IIIa inhibitor (antithrombin and offer drug eluting stent)

Z Year3 Cardio Conditions (22 decks)

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