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Cardio > Acute Coronary Syndrome > Flashcards

Acute Coronary Syndrome Flashcards

1
Q

When does ACS occur

A

When a thrombus blocks a Coronary artery

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2
Q

What are the three types of ACS

A

Unstable Angina
NSTEMI
STEMI

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3
Q

What is the difference between MI and Angina

A

MI is referred to the death of myocardium whereas angina is the underperfusion

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4
Q

What are the non modifiable risk factors for ACS

A

Age
Male
Family history
South Asian

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5
Q

What are the modifiable risk factors for ACS

A 
Smoking
HTN
Hyperlipidaemia
Obesity
Diabetes
Sedentary Lifestyle
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6
Q

What is the difference between STEMI and NSTEMI

A 
STEMI= complete occlusion
NSTEMI = Severe occlusion
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7
Q

When can NSTEMIs occur n a non occlusive setting

A

Severe sepsis
Hypotension
Hypovolemia
Coronary Artery Spasm

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8
Q

What is the presentation of ACS

A

Central CRUSHING Chest pain
Radiates to neck jaw and arms
Present with N+V, sweating, SOB or syncope

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9
Q

What are some non MI causes of Chest pain

A 
C- Myocarditis/Pericarditis
C- Cardiomyopathy
C -Valvular disease
C- Aortic Dissection
P- PE
P- Pneumonia
P- Pneumothorax
R- Costochondritis
R- Herpes
G- Oesophageal spasm
G- Cholecystitis
G-Pancreatitis
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10
Q

Describe Troponin levels in unstable angina, STEMI and NSTEMI

A 
Unstable= normal troponin
NSTEMI= Raised troponin
STEMI= Raised troponin
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11
Q

Describe the ECG Changes for Unstable, STEMI and NSTEMI

A

UNSTABLE =NORMAL/ST DEPRESSION
NSTEMI = NORMAL/ST DEPRESSION
STEMI = ST ELEVATION/LBBB

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12
Q

How would you diagnose a STEMI

A

ST elevation
->2mm in chest lead
->1mm in limb leads
LBBB with chest pain

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13
Q

How would you diagnose NSTEMI

A

Raised troponin
Chest pain
Abnormal ECG

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14
Q

What is the initial investigation of ACS

A

ECG

STEMI= urgent referral

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15
Q

After ECG what should you investigate

A 
Bloods
Troponin (3hrs after pain starts)
FBC and CRP (Infection?)
D-Dimer (PE?)
Chest X ray (pulmonary oedema?)
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16
Q

An RCA STEMI would be present on what leads and myocardium area

A

II, III and aVF

Inferior myocardium

17
Q

A LAD STEMI would be found on what leads and area

A

V1-V6
(V1-V2 = Poximal LAD at septal)
(V3-V4 = LAD at Anterior)
V5-V6 =Distal LAD at Apex)

18
Q

An LCx STEMI would be found on what leads and area

A

I, aVL

Lateral Myocardium

19
Q

An RCA/LCx STEMI would be found on what leads and area

A

V7-V9 with ST depression at V1-V3

Posterolateral myocardium

20
Q

What is Troponin

A

A protein marker of dead cardiomyocytes which raise 3hrs after MI

21
Q

What are some non ACS causes of raised Troponin

A 
Myocarditis and Pericarditis
Arrythmia
Heart Fail
Type A Aortic Dissection
Sepsis
Strenuous Exercise
22
Q

What is the managment for ACS

A 
"What's HAPON"
H- Hospital (PCI IMMEDIATE if STEMI)
A- Aspirin w/ Clopidogrel
P- Pain relief (morphine)
O- Oxygen
N- NItrates
23
Q

What is the management for STEMI

A 
ACS Management then ......
Before PCI
-Prasugrel (not on anti-coag) 
-Clopidogrel (on anti coag)
PCI (<2hr of medical contact)
Thrombolysis (>12hr of symptoms)
24
Q

Why may you choose clopidogrel over prasugrel

A

Clopidogrel should be used if the patient is on anticoagulation already

25
Q

What is the management of NSTEMI

A 
Oxygen >90
Aspirin with GRACE score
if low risk = prasugrel/ticragelor
if high risk = clopidogrel
GTN for symptom relief
IV morphine (decrease preload)
Start LMWH or Fondaparinux
26
Q

What is the Post MI management

A 
Aspirin 75mg with clopidogrel 75 mg (Anti Platelet)
Bisoprolol (BB)
Ramipril (CCB)
Atorvastatin
-do ECHO = heart fail?
-do cardiac rehab
27
Q

What are the main complications of MI

A 
Heart fail
-Ventricular fibrillation
-Mitral Incompetence
-LV rupture
-Cardio shock
Dressler's
28
Q

How does ECG change after an MI

A

Hyperacute T wave
Deep Q wave
LBBB

29
Q

What is the difference between T1 and T2 MI

A

T1- IHD

T2 - Demand / Vasospasm

30
Q

How does occlusion change between unstable, NSTEMI and STEMI

A 
Unstable = Minor
NSTEMI = Major
STEMI = Total
31
Q

How does infarction change between unstable, NSTEMI and STEMI

A 
Unstable = Only ISCHEMIA
NSTEMI = Sub endo infarction
STEMI = Transmural infarction
32
Q

What investigation shows the extent of occlusion

A

CT Coronary Angiogram

33
Q

Why is alteplase used in thrmobolysis of a STEMI

A

Clot buster

-Activates plasmin which decreases fibrin

34
Q

What is the long term prevention of ACS

A

Beat Blocker
Aspirin (300mg load then 75mg) w/ Clopidogrel
Atorvastatin
ACE inhibitor

Cardio (26 decks)

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