Acute Coronary Syndrome

Question 1

What are the symptoms of an MI?

Answer 1

central constricting chest pain
pain radiating to jaw or ears
nausea and vomiting
sweating
feeling of impending doom
palpitations
symptoms continue at rest for >15min

Question 2

What ECG changes are seen in an STEMI? And NSTEMI?

Answer 2

STEMI
- ST segment elevation
- new left bundle branch block
NSTEMI
- ST segment depression
- T wave inversion

Question 3

What do pathological Q waves suggest? When do these appear?

Answer 3

deep infarction involving the full thickness of the heart
appear 6+ hours after symptom onset

Question 4

What two tests are done to confirm a heart attack and the type?

Answer 4

ECG
troponin blood test

Question 5

In which type of acute coronary syndrome would there be raised troponin levels?

Answer 5

NSTEMI

Question 6

What other conditions can give a rise in troponin level?

Answer 6

CKD
sepsis
myocarditis
aortic dissection
pulmonary embolis

Question 7

How to you classify acute coronary syndrome based on ECG and blood results?

Answer 7

STEMI - ST elevation or new LBBB and raised troponin levels
NSTEMI - raised troponin and normal ECG or alternative changes
unstable angina - normal troponin and alternative ECG changes

Question 8

What is the initial management of a MI?

Answer 8

ECG
aspirin 300mg
IV morphine for pain if needed
GTN

Question 9

What is post MI thrombolysis?

Answer 9

Subcutaneous injection of a fibrinolytic agent to break down fibrin in blood clots

Question 10

When would you give an angiography following an MI?

Answer 10

if the GRACE score (6 month probability of death following NSTEMI) is >3%

Question 11

What test would be carried out following the initial management of acute coronary syndrome?

Answer 11

echocardiogram

Question 12

What treatments are given as secondary prevention following an acute coronary event?

Answer 12

75mg aspirin daily ongoing
other anti platelet for 12 months
ACE inhibitor (ramipril)
atenolol (or other beta blocker)
aldosterone antagonist if clinical heart failure

Question 13

Why is it important to monitor renal function once a patient is started on ACE inhibitors and aldosterone antagonists?

Answer 13

both can cause hyperkalaemia

Question 14

What is the name of the condition that occur 2-3 weeks following an MI whereby the pericardium becomes inflamed?

Answer 14

Dressler’s syndrome

Question 15

What are the symptoms of Dressler’s syndrome?

Answer 15

pleuritic chest pain
low grade fever
pericardial rub on auscultation (rubbing, scratching sound)

Question 16

How is Dressler’s syndrome diagnosed?

Answer 16

ECG - ST elevation, T wave inversion
echocardiogram - pericardial effusion
raised CRP and ESR

Question 17

How is Dressler’s syndrome managed?

Answer 17

NSAIDs (aspirin/ ibuprofen)
steroids (prednisolone)
pericardiocentesis to remove fluid from around heart if severe