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Week 5 > Acute coronary syndrome > Flashcards

Acute coronary syndrome Flashcards

1
Q

Right coronary artery (RCA) supplies which parts of the heart?

(4)

A
  • R atrium
  • R ventricle
  • Inferior aspect of the L ventricle
  • Posterior septal area
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2
Q

The left coronary artery becomes the?

(2)

A
  • Circumflex artery
  • Left anterior descending (LAD)
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3
Q

Which parts of the heart does the circumflex artery supply?

A
  • Left atrium
  • Posterior aspect of left ventricle
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4
Q

Which part of the heart does the LAD supply?

A

Anterior aspect of the L ventricle
Anterior aspect of the septum

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5
Q

Suspect ACS if pain is in the and lasts for how long?

A

Chest, arms, back or jaw and lasts longer than 15 mins

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6
Q

In ACS the chest pain will be described as?

A
  • Dull, central and/or crushing
  • Will occur with little or no excergion and often lasts longer than 15 mins
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7
Q

In ACS what is teh chest pain associated with?

A
  • Nausea, vomitting, sweating, breathlessness, palpitations
  • Associated with haemodynamic instabiity ( systolic PB less than 90)
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8
Q

What test can be done to differntiate unstable angina from MI?

A

Serum troponin- remains elevated for up to 2 weeks after an MI
It is realsed from ischaemic heart muscle tissue

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9
Q

What is a silent MI and who is at risk of these?

A

Someone whp does not experince typical chest pain during acute conoary syndrome
* Patienst with diabetes are at risk of these

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10
Q

ECG changes in STEMI?

A

ST elevation
LEft bundle branch block

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11
Q

ECG chnages in NSTEMI?

A

ST depression
T wave inversion

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12
Q

Difference between an NSTEMI and STEMI?

A

NSTEMI- partial blockage of artery- can be diagnosed with troponin levels- high or rising= NSTEMI

STEMI- complete blockage- diagnosed on clinical findings and ECG

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13
Q

Alternative causes of raised troponin levels? (5)

A
  • Chronic kidney disease
  • Sepsis
  • Myocarditis
  • Aortic dissection
  • Pulmonary embolism
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14
Q

STEMI is diagnosed when investigations show?

A

ECG shows either ST elevatio or new left bundle branch block

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15
Q

NSTEMI is diagnosed when investigations show?

A

Raised troponin with
* A normal ECG
* Other ECG chnages (ST depression or T wave inversion)

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16
Q

Unstable angina is diagnosed when investigations show?

A

Symptoms suggest ACS
Troponin is normal and either
* Normal ECG
* ECG chnages (ST depression or T wave inversion)

17
Q

Initial management of chest pain? “CPAIN”

A

Call an ambulance
Perform an ECG
Aspirin 300mg
Intravenous morphine for the pain if required
Nitrate (GTN)

18
Q

Management of STEMI presenting witin 12 hours of onset?

A
  • Percutaneous coronary intervention (PCI)- within 2 hours of presentation
  • Thrombolysis
19
Q

What is percutaneous coronary intervention (PCI)?

A

Catheter into the patients radial or femoral artery undr x-ray guidance and injecting contrast to identify the blockage (angiography)

Blocakges can be treated with an angioplasty- balloon to widen the lumen of the artery and then stent inserted to keep the artery open

20
Q

What is thrombolysis?

A

Injecting fibriolytic agent which breaks down fibrin in blood clots

21
Q

Managment of NSTEMI? (BATMAN)

A

B- base the decsion about angiography or PCI on the GRACE score
A- Aspirin 300mg stat
T- Ticagrelor 180mg stat
M- morphine to control pain
A- Antithrombinn therapy with fondaparinux
N- Nitrate

22
Q

What does the GRACE score predict in NSTEMI management?

A

Gives a 6 month probability of death after having an NSTEMI
* 3% or less is considered low risk
* Above 3 % is considered medium to high risk

23
Q

What is Dressler’s syndrome and how does it present? Diagnosed and managed?

A

Also called post-myocardial infarction syndrome- usually occurs 2-3 weeks after MI- immune response causes inflammation to the pericardium

Presents:
* Pleuritic chest pain
* Low grade fever
* Pericardial rub on auscultation

Diagnosis:
* Made with an ECG- global ST elevation and T wave inversion
* echocardiogram
* Raised inflammatory markers (CRP and ESR)

Managment:
* NSAIDs
* Severe cases- steroids

24
Q

Name the condition:
Sudden onset pleuritic pain either left sided or right sided, with associated dyspnoea and syncope

A

Pneumothorax

25
Q

Name the cause:
Pain typically persistent (typically days or longer), worsened with passive and active motion and sometimes reproducible chest tenderness.

A

Musculoskeltal

26
Q

Name the cause:
Exertional pain/discomfort in the centre or left side of chest, throat, neck or jaw relieved by rest or GTN within a few minutes. May radiate to neck, jaw or left arm. Sometimes there may not be any pain but breathlessness (angina equivalent).

A

Angina

27
Q

Name the condition:
Constant or intermittent central pleuritic sharp pain often aggravated by position (classically worse on lying down and relieved by sitting or leaning forward)

A

Pericarditis

28
Q

Name the condition:
Recurrent, vague epigastric discomfort, that is relieved by food, antacids, or both

A

Peptic ulcer disease

29
Q

Name the conditon:
Sudden onset pleuritic pain with associated dyspnoea and tachycardia. Sometimes mild fever, haemoptysis and syncope

A

Pulmonary embolism

30
Q

Name of the tool used in GP to determine a patients cardiovascular risk?

A

QRISK3- established a patients 10 year risk of cardiovascular events

31
Q

Drugs used in secondary prevention in people who have had an MI?

A

ACE inhbitor
Antiplatelet therapy
Beta-blocker
Statin

32
Q

What is angina and difernce between stable and unstable angina?

A

Angina= chest pain caused by an insufficient blood supply to myocardium.

Stable- occurs predictably with physical exertion or emotional stress and relived within minutes of rest or GTN spray

Unstable angina- new onset, often occuring at rest- requires immediate admission to hopsital

33
Q

Key side effects of GTN spray?

A

Headaches and dizziness caused by vasodilation

34
Q

Medications for secondary prevention of angina? 4 A’s

A

A- Aspirin 75mg once daily
A- Atorvostatin 80mg once daily
A- ACE inhibitor
A- already on a beta blocker for symptomatic relief

35
Q

What is a Coronary artery bypass graft (CABG)?

A

Offered to patients with severe stenosis
Opens chest along sternum and attch graft vessel to the affected coronary artery, bypassing the stenoitc area

3 main options for graft vessel are:
* Saphenous vein
* Internal thoracic artery
* Radial artery

36
Q

In patient with angina where beta blocker is contraindicated e.g. asthma. What else can be given alongside GTN and verapamil?

A

Long acting nitrate e.g. isosorbide mononitrate

37
Q

Prior to percutaneous coronary intervention (PCI) what are patients given?

A

Dual antiplatelet therapy
* Aspirin and Clopidogrel (if on anticoag already)
* Aspirin and prasugrel (if not on anticoag already)

38
Q

Patients undergoing fibrinolysis for a STEMI should also be given?

A

Antithrombin drug- Fondaparinux

39
Q
A

Week 5 (3 decks)

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