Acute Coronary Syndrome

Question 1

Define Acute coronary syndrome

Answer 1

The manifestation of CAD as increasing symptoms of angina, MI or sudden death

Question 2

Unstable angina is

Answer 2

A type of angina pectorals that can occur at rest or during exertion

Question 3

Unstable angina is due to

Answer 3

Supply-demand mismatch - increased myocardial O2 demand
Plaque disruption - increasing plaque instability leads to plaque rupturing
Thrombosis - thrombosis formation at the site of the atherosclerotic plaque rupture reducing coronary blood supply

Question 4

Diagnosis of an MI is

Answer 4

Rise of cardiac troponin levels, history of cardiac disease and pathological all ECG findings

Question 5

Unstable angina Is categorised by at least one of the following

Answer 5

1) occurs at rest or minimal exertion and usually lasts more than 20min
2) being severe and of new onset (within 1 month)
3) occurs with crescendo pattern (less activity, more severe and prolonged to previous angina)

Question 6

Immediate management of STEMI includes

Answer 6

Aspirin and a primary PCI

Question 7

Pharmacological management of a STEMI includes the use of

Answer 7

Betablockers, ACE-inhibitors, statins

Question 8

Nitroglycerin causes

Answer 8

Vasodilation of coronary arteries, increasing blood flow to the heart. Also causes peripheral venous and artery dilation reducing preload and after load

Question 9

How long after an MI is sub maximal exercise testing recommended

Answer 9

4-6 days after acute MI

Question 10

How long after MI is a GXT recommended

Answer 10

14-21 days

Question 11

Inpatient Px

Answer 11

F - mobilisation (2-4x/day)
I - 20bpm + resting
T - intermittent bouts of 3-5 min 
T - walking, ADLS, flexibility, ROM
P - when individual can walk for 10-15 min increase intensity

Question 12

Methods of prescribing intensity of outpatient rehab

Answer 12

40-80% of ex capacity using HRR, VO2R or peak oxygen uptake
RPE of 11-16
10 beats below is ischemic threshold

Question 13

Symptoms of MI

Answer 13

Increased respiratory rate, cool and pale skin, low grade fever, BP may be elevated or decreased, irregular HR

Question 14

Sudden thrombotic occlusion of a previously minimally obstructive coronary artery provides a potent stimulus for

Answer 14

Platelet aggregation and thrombosis formation

Question 15

ECG characteristics seen in an MI

Answer 15

ST elevation or depression, pathological Q waves