Acute Coronary syndrome

Question 1

What is required in the examination/investigations to diagnose an MI?

Answer 1

Raised troponin level plus one of the following:

• symptoms of ischaemia
• new ECG changes
• evidence of coronary problem on angio or autopsy
• evidence of new cardiac damage on another test

Question 2

Which type of MI gives Q waves on the ECG 3 days later?

Answer 2

STEMI

Non STEMI shows absent Q waves

Question 3

What are non cardiac causes of raised troponin?

Answer 3

Pulmonary embolism
Sepsis
Renal failure
Sub-arachnoid haemorrhage

Question 4

Give other causes of MI which don’t relate to coronary atherosclerosis.

Answer 4

Coronary vasospasm i.e. from coccaine, triptans (anti-migraine), 5-FU (chemotherapy)
Coronary dissection - tear in one of the coronary arteries
Embolism of material down coronary artery- thrombus from mechanical valve, tumor, AF
Inflammation of coronary arteries I.e. vasculitis
Radiotherapy to chest can cause fibrosis and stenosis of coronary arteries

Question 5

If there is a complete blockage in the right coronary artery, where would the MI occur?
If there was blockage in the left anterior descending coronary artery, where would the MI occur?
If there was complete blockage in the circumflex coronary artery, where would the MI occur?

Answer 5

Inferior MI
Anterior MI
Lateral MI

Question 6

On examination of someone with a suspected MI, what are checked to ensure that their symptoms aren’t due to something else?

Answer 6

HR
BP
Murmours
Crackles in chest

Question 7

What is the 2 choices of repercussion therapy?

Answer 7

Cath lab for Percutaneous Coronary Intervention PCI (angioplasty and stenting)
Pharmacological I.e. thrombolysis therapy

Question 8

What is the thrombolysis therapeutic drug which is given as a rapid injection if its an emergency?

Answer 8

Tenecteplase TNK

Question 9

What if the function of thrombolysis therapy?

Answer 9

Dissolves the clot

Question 10

How do you decide wether the patients needs the cath lab or thrombolysis therapy?

Answer 10

Thrombolysis therapy may not work if they have a delayed presentation
It’s the question, can the patient make it to the cath lab in 2 hours?
If they cant then thrombolysis and then transfer to cath lab
If they can then immediately to the cath lab

Question 11

Compared with STEMI, NSTEMI patients are more likely

Answer 11

Older
More likely to have previous MI
More likely to have previous CABG/PCI
Also may not have such a clear ‘coronary’ presentation

Question 12

What investigations should be carried out for investigating suspected Acute coronary syndrome?

Answer 12

ECG - consider posterior leads
Chest X ray - rule out any other causes
Bloods - check not anemic, check kidney function, cholesterol and thyroid

Question 13

What are the risks of coronary angioplasty/stenting/angiography

Answer 13

Bleeding
Blood vessel damage
Myocardial infarction (blocking off an artery with a stent)
Coronary perforation
Stroke
Dye can affect kidneys

Question 14

What are the complications following an MI?

Answer 14

Arrhythmia
Mechanical such as 
- cardiogenic shock 
- myocardial rupture
- valve dysfunction due to papillary muscle rupture
- a cute ventricular septal defects

Question 15

What is done pre-discharge of a patient who suffered an MI?

Answer 15

Check on correct medications
Address risk factors
Cardiac rehabilitation
Follow-up plans

Question 16

What is the common pathogenesis is causing acute coronary syndrome?

Answer 16

(Regrading an atheromatous plaque)
Complete or sub complete occlusion of the vessel
Platelet aggregation causing thrombus formation
Plaque rupture or erosion
Vasoconstriction and vasospasm

Question 17

What are the types of MI?

Answer 17

Type 1 - spontaneous MI with ischameia due to primary coronary event I.e. atheromatous plaque
Type 2- MI secondary to ischaemia due to increased 02 demand or decreased 02 supply
Type 3 - diagnosis of MI in sudden cardiac death
Type 4a- MI related to PCI
Type 4b - mi related to stent thrombosis
Type 5- MI related to CABG