Acute coronary syndrome

Question 1

describe cardiac chest pain

Answer 1

central, retrosternal, band-like constriction
non pleuritic (ie not sharp or worse on breathing)
with radiation to the neck/jaw/shoulder/arm
can associated with nausea and vomiting

Question 2

name 6 risk factors for acute coronary syndromes

Answer 2

HTN
CKD
hyperlipidaemia
FHx
smoking
Diabetes

Question 3

chest pain, trop rise and ST elevation - what is it?

Answer 3

STEMI

Question 4

Chest pain, no trop rise, no ECG changes- what is it?

Answer 4

unstable angina

Question 5

chest pain, trop rise, no st elevation- what is it?

Answer 5

NSTEMI

Question 6

what are some complications of a myocardial infarction? (do you know a mnemonic?)

Answer 6

Pump failure
Rupture of papillary muscles or septum
Arrhythmias and aneurysm
Embolism
Dresslers syndrome (plus early acute pericarditis)

Question 7

what are 6 qualities of pericardial pain?

Answer 7

2 like pleurisy: sharp and worse on breathing in
2 like angina: retrosternal and radiates to the left (shoulder not arm)
2 of its own: worse only flat and eases on leaning forward

Question 8

what ECG changes would be present in pericarditis?

Answer 8

‘saddle-shaped’ ST elevation

PR depression: most specific ECG marker for pericarditis

Question 9

what should all patients with suspected acute pericarditis get?

Answer 9

a transthoracic echo

Question 10

how would you treat acute pericarditis?

Answer 10

a combination of NSAIDs and colchicine is now generally used for first-line for patients with acute idiopathic or viral pericarditis

Question 11

Which statin has been shown to reduce recurrent ischaemic events if administered in the acute setting following an MI?

Answer 11

Atorvastatin