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Cardiology > Acute Coronary Syndrome > Flashcards

Acute Coronary Syndrome Flashcards

1
Q

How is ACS classified?

A
  1. Unstable angina -
  • symptoms of prolonged angina
  • Normal ECG and troponin levels
  1. Non ST elevation ACS
  • Symptoms of MI
  • Raised troponin levels
  • ECG: NO St elevation BUT might have St depression/Twave inversion/no changes
  1. ST elevation ACS
  • Symptoms of MI
  • Raised Troponin levels
  • ECG: ST elevation
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2
Q

What are the risk factors for ACS?

A
  1. NON-MODIFIABLE FOR ATHEROSCLEROSIS
    * increase age / male / FHx premature ACS / premature menopause
  2. MODIFIABLE ATHEROSCLEROSIS
    * smoking / DM / HTN / dyslipidaemia / obesity / lack of exercise
  3. NON ATHEROSCLEROSIS
    * Cocaine use / infected valve / severe anaemia / coronary occlusion / thyrotoxicosis
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3
Q

What are the clinical features of ACS?

A
  1. Central crushing chest pain radiating to neck and left arm 2. SOB / pallor / palpitations / nausea & vomiting / sweating / fatigue
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4
Q

What are the DDx of chest pain?

A
  1. CARDIOVASCULAR
    * acute pericarditis / myocarditis / PE / aortic stenosis / aortic dissection
  2. RESPIRATORY

Pneumonia / pneumothorax

  1. GASTROLOGY

oesophageal spasm / oesophagitis / GORD / cholecystitis / acute pancreatitis

4. Musculoskeletal chest pain

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5
Q

What are the main investigations for ACS?

A

1. ECG 12 Lead

ST Elevation, ST depression T wave inversion

2. Cardiac Troponin I & T

Detectable 3 to 6 hours after infarction & peak at 12-24

3. Bloods

CRP (marker acute inflammation), FBC (suspected anaemia), Blood glucose (high incidence ACS w/ hyperglycaemia)

4. Imaging

Echo, CXR, CMR (structural abnormalities for Ddx)

5. Coronary angiography*

(severity on coronary artery disease)

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6
Q

What is the initial treatment for unstable angina and NSTEMI?

A

1. Aspirin 300mg

  • Clopidegrel if aspirin sensitive

2. Fondaparinux if no bleeding risk and coronary angioplasty not planned in next 24h

OR

Heparin if coronary angioplasty likely within 24h or creatinine >256umol

3. Nitrates and morphine for chest pain

NB: NO Oxygen unless desaturated

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7
Q

What is the risk assessment score for unstable angina and NSTEMI?

A

GRACE score

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8
Q

What is management of low risk patient from GRACE score?

A

Aspirin 75mg indefinitely

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9
Q

What other emdication should be given to NSTEMi patients?

A
  1. Clopidegrel 300mg (continue for 12 months)

2. IV glycoprotein receptor antagonists (e.g. EPTIFIBATIDE or TIROFIBAN) if scheduled for angiography within 96h

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10
Q

What is the MOA of aspirin?

A

Antiplatelet - inhibits production thrombaxane

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11
Q

What is MOA of clopidegrel?

A

Antiplatelet - inhibits ADP biding to its platelet receptor

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12
Q

What is MOA of fondaparinux?

A

Activates antithrombin III ==> potentiates inhibition of coagulation factors Xa

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13
Q

Which vessel and area of heart is involved in V1-V4 ST elevation?

A

LEFT ANTERIOR DESCENDING

ANTERIOR AREA

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14
Q

Which vessel and area of heart is involved in II, III, aVF ST elevation?

A

RIGHT CORONARY ARTERY

Inferior area

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15
Q

Which vessel and area of heart is involved in I, V5-6 ST elevation?

A

LEFT CIRCUMFLEX BRANCH

Lateral Area

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16
Q

What is initial management of STEMI?

A
  1. Aspirin 300mg
  2. GTN spray
  3. Morphine
  4. Metaclopramide (anti emetic)

NB: ONLY OXYGEN IF SATS <94%

17
Q

What is the standard managment of STEMI?

A
  1. PCI FIRST LINE TREATMENT

Management before PCI includes

  1. Clopidegrel (or other antiplatelet)
  2. Bivalirudin (direct thrombin inhibitor)
  3. Heparin
18
Q

What is given if PCI cannot be offered in STEMI?

A
  1. Fibronolysis

IF

  • Onset within 12h
  • PCI no offered w/i 120 mins
19
Q

What fibronolysis drugs are used and how do they work?

A

Drugs: ALTEPLASE, TENECTEPLASE, STREPTOKINASE

MOA: Thrombolytic drugs activate plasminogen to form plasmin ==> degrades fibrin ==> breaks up thrombi

20
Q

What are the contraindications to fibrinolysis?

A
  • Active internal bleeding
  • Recent haemorrhage, trauma, surgery
  • Coagulation & bleeding disorders
  • Stroke < 3 months
  • Pregnancy
  • Recent head injury
  • Severe HTN
21
Q

What are the side effects of fibrinolysis?

A
  • Haemorrhage
  • Hypotension (esp streptokinase)
  • Allergic reaction
22
Q

Other causes of raised troponin?

A
  • Heart failure
  • Myocarditis
  • Pulmonary Embolism
  • Renal fialure
  • Severe sepsis
  • Supraventricular tachycardia

Cardiology (22 decks)

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