Acute Coronary Syndrome

Question 1

Acute Coronary Syndrome - types

Answer 1

• unstable angina
• ST elevation MI
• Non-ST elevation MI

Question 2

Acute Coronary Syndrome - symptoms

Answer 2

• Chest pain or discomfort
• Pain or discomfort in one or both arms, the jaw, neck, back or stomach
• Shortness of breath
• Feeling dizzy or lightheaded
• Nausea
• Sweating

Question 3

Acute Coronary Syndrome - causes of a STEMI

Answer 3

• ST elevation
• new left bundle branch block

Question 4

Acute Coronary Syndrome - no ST elevation

Answer 4

troponin blood test
- raised troponin –> NSTEMI
- normal troponin –> unstable angina (if no changes on ECG)

Question 5

Acute Coronary Syndrome - diabetes

Answer 5

no typical chest pain

Question 6

Acute Coronary Syndrome - STEMI ECG changes

Answer 6

• ST segment elevation
• new left bundle branch block

Question 7

Acute Coronary Syndrome - NSTEMI ECG changes

Answer 7

• ST segment depression
• deep T wave inversion
• pathological Q waves

Question 8

Acute Coronary Syndrome - troponin

Answer 8

• rise –> MI
• troponins are non-specific

Question 9

Acute Coronary Syndrome - raised troponin alternative causes

Answer 9

• chronic renal failure
• sepsis
• myocarditis
• aortic dissection
• PE

Question 10

Acute Coronary Syndrome - Investigations

Answer 10

• physical exam, ECG, FBC, lipid profile
• Chest X-ray (PO)
• ECG (functional damage)
• CT coronary angiogram (coronary disease)

Question 11

Acute Coronary Syndrome - acute STEMI treatment

Answer 11

• primary percutaneous coronary intervention (if available within 2 hours of presentation)
• thrombolysis (if PCI is not available within 2 hours)

Question 12

Acute Coronary Syndrome - PCI

Answer 12

• catheter into the brachial or femoral artery
• under x-ray guidance
  use stent or balloons

Question 13

Acute Coronary Syndrome - thrombolysis

Answer 13

• inject a fibrinolytic (break down fibrin)
• eg. streptokinase

Question 14

Acute Coronary Syndrome - acute NSTEMI treatment

Answer 14

• B - beta blockers
• A - aspirin 300mg
• T - ticagrelor 180mg (clopidogrel 300mg alt)
• M - morphine
• A - anticoag. eg. fondaparinux
• N - nitrates eg GTN

Question 15

Acute Coronary Syndrome - complications of MI

Answer 15

• D - death
• R - rupture of heart septum/pap muscles
• E- edema (heart failure)
• A - arrhythmia and aneurysm
• D - dressers syndrome

Question 16

Acute Coronary Syndrome - Dresslers syndrome

Answer 16

aka post-MI syndrome
- 2-3 weeks after MI
- localised immune response –> pericarditis

Question 17

Acute Coronary Syndrome - Dresslers syndrome symptoms, diagnosis, management

Answer 17

Symptoms
- pleuritic chest pain
- low-grade fever
- pericardial rub

Diagnosis
- ECG

Management
- NSAIDs
- steroids (prednisolone)

Question 18

Acute Coronary Syndrome - secondary prevention medical

Answer 18

• Aspirin (75mg)
• Another antiplatelet (clopidogrel)
• Atorvastatin (80mg)
• ACE inhibitors (ramipril 10mg)
• Atenolol
• Aldosterone antagonist (eplerenone)

Question 19

Acute Coronary Syndrome - secondary prevention lifestyle

Answer 19

• stop smoking
• reduce alcohol consumption
• Mediterranean diet
• cardiac rehab

Question 20

Acute Coronary Syndrome - types of MI

Answer 20

• Type 1: Traditional MI due to an acute coronary event
• Type 2: Ischaemia secondary to increased demand or reduced supply of oxygen (e.g. secondary to severe anaemia, tachycardia or hypotension)
• Type 3: Sudden cardiac death or cardiac arrest suggestive of an ischaemic event
• Type 4: MI associated with PCI / coronary stunting / CABG