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Emergency medicine > Acute coronary syndrome > Flashcards

Acute coronary syndrome Flashcards

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Royal College: Emergency Medicine flashcards
1
Q

Thrombus mostly made up of

A

Platelets

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2
Q

Anti-platelet examples

A

Aspirin
Clopidogrel
Ticagrelor

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3
Q

Left coronary artery becomes

A

Circumflex
Left anterior descending

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4
Q

Right coronary artery supplies

A

Right atrium
Right ventricle
Inferior aspect of left ventricle
Posterior septal area

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5
Q

Circumflex artery supplies

A

Left atrium
Posterior aspect of left ventricle

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6
Q

Left anterior descending supplies

A

Anterior aspect of left ventricle
Anterior aspect of septum

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7
Q

Symptoms of ACS

A

Central crushing chest pain
Nausea and vomiting
Sweating and clamminess
Feeling of impending doom
SOB
Palpitations
Pain radiation to jaw or arms

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8
Q

STEMI ECG changes

A

ST segment elevation in leads consistent with area of ischaemia
New LBBB

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9
Q

NSTEMI ECG changes

A

ST segment depression
Deep T wave inversion
Pathological Q waves (suggesting a deep infarct- late sign)

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10
Q

Left coronary artery ECG leads

A

I
aVL
v3-6

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11
Q

LAD ECG leads

A

V1-4

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12
Q

Circumflex ECG leads

A

I
aVL
v5-6

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13
Q

Right coronary artery ECG leads

A

II
III
aVF

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14
Q

Alternative causes of raised troponins

A

Chronic renal failure
Sepsis
Myocarditis
Aortic dissection
PE

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15
Q

Acute STEMI treatment

A

Primary PCI (if available within 2 hours presentation)
Thrombolysis (if PCI not available)

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16
Q

PCI

A

Catheter through brachial/ femoral artery
Under xray guidance and inject contrast to identify area of blockage

17
Q

Thrombolysis

A

Inject fibrinilytic medication to dissolve clot

Streptokinase, alteplase, tenecteplase

18
Q

Acute NSTEMI treatment

A

Beta blockers
Aspirin (300mg stat)
Ticagrelor (180mg stat)
Morphine tirate to control pain (only if severe pain)
Anticoagulant- fondaparinux
Nitrates

Oxygen if sats dropping

19
Q

GRACE score

A

6 month risk of death or repeat MI after NSTEMI

<5% low risk
5-10% medium risk
>10% high risk

Medium or high considered for early PCI

20
Q

Complications of MI

A

Death
Rupture of heart septum or papillary muscles
Edema (heart failure)
Arrythmias and aneurysm
Dressler’s syndrome

21
Q

Dressler’s syndrome

A

Occurs 2-3 weeks after MI

Caused by immune response and causes pericarditis

22
Q

Dressler’s syndrome presentation

A

Pleuritic chest pain
Low grade fever
Pericardial rub

Can cause pericardial effusion and pericardial tamponade

23
Q

Dressler’s syndrome management

A

NSAIDs (aspirin/ ibuprofen)

Steroids in more severe cases

May need pericardiocentesis

24
Q

Secondary prevention medical management

A

Aspirin 75mg OD
Another antiplatelet e.g. clopidogrel or ticargreol for up to 12 months
Atorvastatin 80mg OD
ACEi
Atenolol
Aldosterone antagonist for those with clinical heart failure

25
Q

Secondary prevention lifestyle

A

Stop smoking
Reduce alcohol consumption
Mediterranean diet
Cardiac rehabilitation
Optimise treatment of other medical conditions

26
Q

Killip class

A

System used to stratify risk post MI

27
Q

Killip class I

A

No clinical signs of HF

6% 30 day mortality

28
Q

Killip class II

A

Lung crackles
S3

17% 30 day mortality

29
Q

Killip class III

A

Frank pulmonary oedema

38% 30 day mortality

30
Q

Killip class IV

A

Cardiogenic shock

81% 30 day mortality

31
Q

STEMI ECG criteria

A

Clinical symptoms of ACS >20 mins with >20 mins ECG feature in >2 continuous leads:

2.5mm ST elevation in v2-3 in men under 40
2.0mm ST elevation in v2-3 in men over 40
1.5mm ST elevation in v2-3 in women
1mm ST elevation in other leads
New LBBB

32
Q

Drug therapy during PCI

A

Radial access:
- unfractionated heparin with bailout glycopriten IIb.IIIA inhibitor

Femoral access:
- bivalirudin with bailout GPI

33
Q

GRACE calculated using

A

Age
HR/ BP
Killip class and renal function (serum creatinine)
Cardiac arrest on presentation
ECG findings
Troponin levels

Emergency medicine (48 decks)

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