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cardiology > Acute Coronary Syndrome > Flashcards

Acute Coronary Syndrome Flashcards

1
Q

What is the definition of Acute Coronary Syndrome

A

A term used for any condition caused by sudden reduced blood flow to the heart

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2
Q

What are the different types of ACS

A

Unstable angina - pain without an enzyme rise (so no evidence of necrosis)
NSTEMI - chest pain with positive markers of necrosis (ie. troponin) but no ST elevation
STEMI - chest pain with ST elevation on ECG

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3
Q

What does the ST segment on an ECG correspond to

A

The interval between ventricular depolarization and repolarization

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4
Q

What does ST elevation on an ECG indicate

A

Full-thickness ischaemia

Usually due to thrombosis of an unstable plaque in a coronary artery causing total occlusion

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5
Q

What does ST depression or T wave abnormalities on an ECG indicate

A

Subtotal or transient occlusion (ie. NSTEMI)

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6
Q

Where is the ST elevation in an anterior MI

A

ST elevation in leads V1-4

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7
Q

What artery is occluded in an anterior MI

A

Left anterior descending artery

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8
Q

Where is the ST elevation in an inferior MI

A

ST elevation in leads II, III, aVF

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9
Q

What artery is occluded in an inferior MI

A

Right coronary artery or circumflex coronary artery

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10
Q

Where is the ST elevation in a lateral MI

A

ST elevation in leads V4-6

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11
Q

What artery is occluded in a lateral MI

A

Circumflex coronary artery

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12
Q

What ECG changes would you expect in a posterior MI

A

Prominent R wave in V1 and V2 with ST depression
Mirror image of anterior MI

*Flip ECG upside down and look through the back of the paper

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13
Q

What artery is occluded in a posterior MI

A

Right coronary artery or circumflex coronary artery

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14
Q

Where is the ST elevation in an anterolateral MI

A

ST elevation in leads V1-6

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15
Q

What artery is occluded in an anterolateral MI

A

Proximal left anterior descending artery

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16
Q

What is troponin

A

Proteins that form part of the myocardial cell structure

Release into the bloodstream indicates myocardial cell damage

17
Q

How long does it take troponin levels to rise after onset of MI

A

6-14 hrs

18
Q

How long do the troponin level stay elevated after an MI

A

Up to 14 days

19
Q

When does CK-MB begin to rise after an MI

A

At least 4 hrs

20
Q

How long does CK-MB stay elevated for after MI

A

Falls within 72 hrs

21
Q

Why should you request an FBC after an MI

A

Anaemia may precipitate an acute MI in a patient with angina

22
Q

When should you measure serum cholesterol after an MI

A

Within 24 hrs or 2 months after

Cholesterol levels drop to artifical low 24hrs after MI

23
Q

What is the acute management of acute MI

A

Oxygen sats maintained over 94% with supplemental oxygen
Aspirin - 300mg orally immediately
Glyceryl trinitrate immediately
Morphine - 2-4 mg IV every 5-15 mins with 10mg metoclopramide

24
Q

What is the time window for the benefit of reperfusion post-MI

A

Greatest benefit within 3hrs

Little benefit after 12 hrs

25
Q

What are the option for reperfusion following an MI

A

Coronary angioplasty

Thrombolysis (with recombinant tissue plasminogen activator) - if timely coronary angioplasty not achievable

26
Q

What are the indications for coronary angioplasty

A

History of chest pain lasting less than 24hrs
ECG changes (one of):-
ST elevation over 1mmin standard leads or 2 adjacent chest leads
New bundle branch block on ECG

27
Q

What are the contraindications for coronary angioplasty

A

History of haemorrhagic cerebrovascular event
History of any CVA event in the last 6 mths
Recent GI bleed
Recent surgery
Pregnancy

28
Q

What are the complications of MI

A

Shock
Structural complications causing - acute MR, VSD
Arrhythmias
Heart failure

29
Q

What medications would a patient be discharged from hospital with following an MI

A 
Aspirin - long term
Clopidogrel - at least 1 year
Statin
ACE-I
Beta blocker

cardiology (15 decks)

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