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Year 4: Cardiology > Acute Coronary Syndrome > Flashcards

Acute Coronary Syndrome Flashcards

1
Q

what are the three types of ACS

A

unstable angina

ST elevation MI

Non-ST elevation MI

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2
Q

What causes ACS

A

thrombus from atherosclerotic plaque blocking a coronary artery

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3
Q

symptoms of ACS

A

central chest pain - heavy, constricting pain may radiate to jaw/arm

dyspnoea

sweating

nausea + vomiting

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4
Q

key investigations for suspected ACS

A

12 lead ECG

troponin levels

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5
Q

features of STEMI on ECG

A

ST elevation corresponding to areas of ischaemia

  • ECG here shows ST elevation in leads II, III, AvF

New LBBB is also considered an STEMI

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6
Q

features of an NSTEMI on ECG

A

ST depression

T wave inversion

Pathological Q waves - late sign suggesting deep infarct

  • ECG here shows ST depression in leads I-III, AvF, V3-V6
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7
Q

Anterior MI affects which leads?

what vessel is occluded?

A

Anterior = V2 - V5

Left anterior descending

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8
Q

anterospetal MI affects which leads?

which vessel is occluded?

A

anteroseptal = V1 - V3

Left anterior descending

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9
Q

anterolateral MI affects which leads?

which vessel is occluded?

A

anterolateral = I, AvL, V4 - V6

left circumflex

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10
Q

inferior MI affects which leads?

which vessel is occluded?

A

inferior = II, III, AvF

right coronary

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11
Q

what are troponins?

are they specific to ACS?

A

proteins found in cardiac muscle - released due to myocardial ischaemia

Non- specific! can also be raised by:

  • chronic renal failure
  • sepsis
  • myocarditis
  • aortic dissection
  • PE
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12
Q

acute management of ACS

A

MORPHINE

OXYGEN (If sats <94%)

NITRATES

ASPIRIN

+ CLOPIDOGREL / TICAGRELOR IN STEMI

(+ metoclopramide as anti-emetic)

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13
Q

Management of STEMI presenting

  • within 2 hours
  • over 2 hours
A

STEMI within 2 hours = PCI

STEMI >2 hours = thrombolysis with streptokinase

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14
Q

what score is used to assess risk of death/ repeat MI in NSTEMI patients

A

GRACE score

  • high risk patients are considered for PCI within 4 days of admission
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15
Q

management of an NSTEMI

A

BETA BLOCKER (unless contraindicated)

ASPIRIN 300mg

TICAGREGLOR 180mg

MORPHINE

ANTICOAGULANT (LMWH e.g. fondaparineux, enoxaparin)

NITRATES

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16
Q

what is dresslers syndrome

A

pericarditis 2-3 weeks post MI

  • Pleuritic chest pain that improves on sitting forward
  • low grade fever, pericardial rub
17
Q

ECG changes pericarditis

A

widespread saddle shaped ST elevation

18
Q

imaging required for all patients with suspected pericarditis

A

transthoracic echo

19
Q

tx of dresslers syndrome

A

NSAIDS

20
Q

drugs for secondary prevention of MI

A

Aspirin 75mg

Antiplatelet e.g ticagreglor

Atorvastatin 80mg

ACE inhibitor

Atenolol

Aldosterone antagonist for those with HF e.g. eplerenone

21
Q

lifestyle advice post MI

A

Stop smoking

reduce alcohol consumption

mediterranean diet

22
Q

most common cause of death post MI

A

Ventricular fibrillation

23
Q

persistent ST elevation + left ventricular failure post MI suggests what?

A

left ventricular aneurysm

  • anticoagulate patient due to increased risk of stroke
24
Q

a patient presenting 1-2 weeks post MI with heart failure secondary to cardiac tamponade (raised JVP, pulsus paradoxus, decreased heart sounds) suggests what?

A

left ventricular free wall rupture

  • urgent pericardiocenteis + thoracotomy is required
25
Q

what murmurs can occur following an MI

A

VSD – continous machinery murmur

Mitral reguary – pan systolic blowing murmur

26
Q

how long do you have to wait before driving a car post MI

A

4 weeks

27
Q

what marker is useful to look for re-infarction in MI

A

CK-MB

  • returns to normal 2-3 days post infarcation so will be raised again if a secondary infarction occurs (unlike Troponins which can remain elevated for some time after the initial infarction)
28
Q

why can heart block occur with an inferior MI?

A

Right coronary artery supplies AV node

  • inferior MI occurs when there is a blockage in the right coronary
29
Q

ECG changes in a posterior MI

A

ST depression + tall R waves in leads V1 - V3

Year 4: Cardiology (12 decks)

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