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Phase 4 cardiology > Acute coronary syndrome > Flashcards

Acute coronary syndrome Flashcards

1
Q

What does the Left coronary artery become?

A

The circumflex and left anterior descending artery

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2
Q

Where does the right coronary artery supply?

A

right atrium
right ventricle
inferior aspect of left ventricle
posterior septal area

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3
Q

Where does the Circumflex artery supply?

A

left atrium

posterior aspect of left ventricle

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4
Q

Where does the LAD supply?

A

the anterior aspect of the left ventricle

anterior aspect of the septum

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5
Q

What are the 3 types of ACS?

A

Unstable angina
ST elevation MI
Non ST elevation MI

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6
Q

When is the diagnosis STEMI?

A

If there is ST elevation or new left bundle branch block

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7
Q

When is the diagnosis nSTEMI?

A

If there is a raised troponin and / or other ECG changes (ST depression or T wave inversion or pathological Q waves)

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8
Q

When is the diagnosis unstable angina?

A

If troponin levels are normal and the ECG does not show pathological changes

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9
Q

What are ACS symptoms?

A 
central, constricting chest pain associated with 
nausea and vomiting
sweating and clamminess
feeling of impending doom
shortness of breath
palpitations
pain radiating to jaw or arms
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10
Q

What heart area is the left coronary artery?

A

anterolateral

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11
Q

What leads is the left coronary artery?

A

i, aVL, V3-V6

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12
Q

What heart area is the LAD?

A

anterior

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13
Q

What leads is the LAD?

A

V1-V4

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14
Q

What heart area is the circumflex artery?

A

Lateral

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15
Q

What leads is the circumflex artery?

A

1, aVL, v5=v6

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16
Q

What heart area is the right coronary artery?

A

inferior

17
Q

What leads is the right coronary artery?

A

II, III, aVF

18
Q

What are some alternative causes of raised troponin?

A 
chronic renal failure 
sepsis
myocarditis
aortic dissection
pulmonary embolism
19
Q

What investigations should be carried out for ACS?

A 
same as stable angina
Physical exam
ECG
FBC (anaemia)
U&E (ACEi)
LFTs (statins)
lipid profile
TFTs
HBA1c

plus
chest xray (chest pain and pulmonary oedema)
Echocardiogram after to assess functional damage
CT coronary angiogram to assess disease

20
Q

What is the treatment for STEMI?

A 
Primary PCI (within 2 hours)
Thrombolysis
21
Q

What are examples of thrombolytic agents?

A

streptokinase
alteplase
tenectaplase

22
Q

Describe PCI

A

putting a catheter into the patients brachial or femoral artery, feeding that up to the coronary arteries under X-ray guidance and injecting contrast to identify the area of blockage. This can be treated using balloons to widen the gap or devices to remove the blockage. usually a stent is inserted to keep the artery open

23
Q

What is acute NSTEMI treatment?

A

BATMAN
Beta blockers
Aspirin 300mg stat dose
Ticagrelor 180mg stat does (clopidogrel 300mg alternative)
Morphine to control pain
Anticoagulant - LMWH - enoxaparin 1mg/kg twice daily for 2-8 days
Nitrates (GTN) to relieve coronary artery spasm
O2 if sats less than 95%

24
Q

What scoring system is used to assess need for PCI in NSTEMI?

A

Grace score

25
Q

What are the complications of MI?

A 
Heart failure DREAD
Death
Rupture of heart septum or papillary muscles 
Oedema (heart failure)
arrhythmia and aneurysm
Dresslers syndrome
26
Q

Describe dressers syndrome

A

post MI syndrome
usually 2-3 weeks after
localised immune response leads to pericarditis

27
Q

How does Dresslers present?

A

pleuritic chest pain
low grade fever
pericardial rub can cause pericardial effusion and rarely tamponade

28
Q

How is dressers diagnosed?

A

ECG (global ST elevation and T wave inversion)
echo (pericardial effusion)
and raised CRP and ESR

29
Q

How is dressers managed?

A

NSAIDs and steroids if severe

may need pericardiocentesis

30
Q

describe secondary prevention medical management after ACS

A 
aspirin 75mg once daily 
Another anti-platelet for 12  months 
Atorvastatin 80mg
ACEi (ramipril)
Atenolol 
Aldosterone antagonist for those with clinical heart failure (eplerenone titrated to 50mg once daily)
31
Q

What are the lifestyle secondary prevention measures post ACS?

A 
stop smoking 
reduce alcohol consumption
mediterranean diet
cardiac rehab
optimise treatment for other medical conditions
32
Q

What is a type 1 MI?

A

traditional due to coronary event

33
Q

What is a type 2 MI?

A

ischaemia secondary to increased demand or reduced supply of oxygen (e.g. anaemia, tachycardia)

34
Q

What is a type 3 MI?

A

sudden cardiac death or cardiac arrest suggestive of an ischaemic evetn

35
Q

What is a type 4 MI?

A

MI associated with PCI / coronary stunting / CABG

Phase 4 cardiology (12 decks)

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