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CVS 2023 > Acute coronary syndrome > Flashcards

Acute coronary syndrome Flashcards

1
Q

Main cause of acute coronary syndrome

A

Atheromatous plaque rupture

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2
Q

Other pathologies of acute coronary syndorome

A
  • Coronary dissection (tear in tunica media)
  • Coronary spasm
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3
Q

Assess for acute coronary syndrome

A

ECG and then measure troponin

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4
Q

NSTEMI ECG could be…

A

ST depression
Inverted T waves
Normal

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5
Q

How to meet diagnosis of acute MI?

A

Increase and/or decrease in cardiac biomarker preferably cardiac troponin

+ 1 of following:
Symptoms of ischaemia
New ST/T wave changes or left bundle branch block
Imaging evidence of wall abnormality (echocardiogram)
Angiography detects thrombus

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6
Q

Type 1 MI

A

Atheromatous plaque rupture, ulceration, fissure, erosion or dissection = thrombus decreasing myocardial blood flow/embolism and then necrosis

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7
Q

Type 2 MI

A

Other than coronary plaque creates instability between demand and supply of myocardial oxygen

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8
Q

Type 2 MI examples

A 
Coronary artery spasm
Coronary endothelial dysfunction
Tachyarrhthmias/Bradyarryhthmias 
Anaemia
Respiratory failure
Hypotension
Severe Hypertension
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9
Q

Assessment of suspected acute coronary syndrome

A 
History:
cardiac sounding?
Radiation to neck/left arm/jaw?
Relieved with GTN (glyceral trinitrate spray, vasodilator)
How long/getting worse?

Risk factors present? (eg diabetes, smoker, high cholesterol, family history)

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10
Q

Examination MI

A 
BP if systolic <90 = cardiogenic shock
Tachy/Bradycardia (2:1 heart block/complete)
JVP - distended (high pressure)
Heart murmur
Cool peripheries?
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11
Q

Inferior ECG leads

A

Lead 2
Lead 3
aVf

(right coronary artery)

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12
Q

Anteroseptal ECG leads

A

V1
V2
V3
V4

(left anterior descending)

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13
Q

Lateral ECG leads

A

Lead 1
aVL
(high lateral)

V5
V6

(left circumflex artery)

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14
Q

Anterior leads

A

V1-V6

left anterior descending

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15
Q

What leads affected if left coronary artery affected?

A

V1-V6 + aVL

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16
Q

What does ST elevation imply?

A

Sudden occlusion

or long term marker of LV aneurysm

17
Q

What does ST depression imply?

A

under supply of blood, not sudden full occlusion

If in anterior leads (V1-V6) can be due to posterior STEMI

18
Q

T wave inversion means

A

Under supply of blood, not sudden occlusion

19
Q

ECG development STEMI

A

Hyperacute T waves (tombstone)
ST elevation
T wave inversion
Pathological Q waves

20
Q

What do you need to do if see ST elevation?

A

Directly to Cath lab for emergency percutaneous coronary intervention (radial or femoral artery entrance)

21
Q

NSTEMI presentation ECG

A

Can be normal
ST depression
Inverted T waves

22
Q

Blood tests NSTEMI

A

Haemoglobin (rule out anaemia as considering antiplatelets)
Renal function (angiogram contrasts can induce nephropathy)
Cholesterol
HBA1C (diabetes)
Troponin

23
Q

When is troponin raised?

A

Raised within 3 hours of damage
Peaks at 24-48 hours
Remains elevated 2+ weeks

24
Q

Other investigations to do

A

Chest X-ray
Rule out pulmonary oedema

If widened mediastinum = aortic dissection maybe

25
Q

Echocardiogram views

A

Apical 2 chamber view : LAD and RCA

Apical 4 chamber view: LAD, RCA and LCA

26
Q

What do we use echocardiogram for?

A

LV function (normal or impaired)
Wall motion
Valvular disease (mitral regurg)
Complications from MI eg VSD

27
Q

Management STEMI

A 
Aspirin (300mg)
P2Y12 inhibitor
Morphine (ease pain) + antisickness drug (metoclopramide)
Nitrate (vasodilator)
Oxygen
Direct transfer cath lab
28
Q

Management NSTEMI

A

Antiplatelets (aspirin/clopidogrel - P2Y12 inhibitors)
Anti-ischaemics (beta blockers, GTN infusion)
Statins
ACE inhibitors

29
Q

NSTEMI when to go to cath lab urgent (for percutaneous coronary intervention)

A

If chest pain persists with dynamic ECG changes

If develop arrhythmias

30
Q

What is invasive coronary angiogram?

A 
X-ray
Local anaesthetic (to access radial or femoral artery)
Wire occluded vessel
Predilate narrowed section with balloon
Stent with metal scaffold
31
Q

Why do we use coronary angiogram?

A

Establishes type of lesion and location

32
Q

Management following stent insertion

A

Life style change (low fat/salt, exercise)
Antiplatelets (DUAL) then aspirin for life
Statin reduce cholesterol <4mmol/L
LDL <2mmol/L
ACE inhibitor BP <140/80`

CVS 2023 (26 decks)

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