Acute coronary syndrome Flashcards

1
Q

What usually causes ACS?

A

thrombus from an atherosclerotic plaque blocking a coronary artery

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2
Q

when a thrombus forms in a fast flowing artery what is the main constituent?

A

platelets

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3
Q

what arteries does the Left coronary artery become?

A

circumflex and left anterior descending

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4
Q

What areas does the right coronary artery supply?

A

right atrium and ventricle
inferior aspect left ventricle
posterior septal area

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5
Q

where does the circumflex artery supply?

A

left atrium

posterior aspect left ventricle

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6
Q

LAD supplies?

A

anterior aspect left ventricle and septum

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7
Q

Three types of ACS

A

non-stable angina
NSTEMI
STEMI

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8
Q

Diagnosis - first thing to do and findings

A

ECG
ST elevation or new left bundle branch block = STEMI
No ST elevation = troponin

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9
Q

troponin levels

A

raised and/or ST depression/t wave inversion = NSTEMI

no raised = unstable angina or MSK pain

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10
Q

Symptoms

A
nausea and vomiting 
sweaty and clamminess 
feeling of impending doom 
SOB
palpitations 
pain radiate to jaw or arms
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11
Q

how long should symptoms last for MI?

A

atleast 20 mins - if not consider unstable angina

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12
Q

silent MI - who to watch out for?

A

diabetics

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13
Q

Heart area and artery

  1. anterolateral
  2. anterior
  3. lateral
  4. inferior
A
  1. Left coronary artery
  2. LAD
  3. circumflex
  4. right coronary artery
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14
Q

What are troponins?

A

proteins found in cardiac muscle

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15
Q

Non ACS causes of raised troponin

A
chronic renal failure 
sepsis 
myocarditis 
aortic dissection 
PE
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16
Q

Additional investigations for MI above those for stable angina

A

CXR - pulmonary oedema
Echo - functional damage
CT coronary angiogram

17
Q

STEMI initial management

A

within 2 hours = primary PCI

PCI not available in 2 hours = thrombolysis

18
Q

thrombolysis

A

injection - break down fibrin to dissolve clots

19
Q

risk of thrombolysis and examples of names

A

bleeding

alteplase

20
Q

Acute NSTEMI treatment - BATMAN

A
beta blocker 
aspirin 300mg
ticagrelor 180mg
morphine 
anticoagulant - LMWH
Nitrates 
oxygen if sats <95%
21
Q

GRACE score

A

6 month risk of death or repeat MI

high risk = early PCI (>10%)`

22
Q

Complications of MI - DREAD

A
Death 
Rupture heart septum 
Edema 
Arrythmia/aneurysm
Dresslers syndrome
23
Q

dresslers syndrome

A

post MI syndrome
2-3 weeks after
localised immune response causing pericarditis

24
Q

how does dresslers syndrome present?

A

pleuritic chest pain, low grade fever and pericardial rub

can cause pericardial effusion and pericardial tamponade

25
Q

diagnosing and managing dresslers syndrome

A
ECG - ST elevation
Echo 
raised crp/esr
Manage with NSAIDs and prednisolone
may need pericardiocentesis
26
Q

6 A’s of secondary prevention

A
aspirin 75mg 
another antiplatelet eg clopidogrel/ticagrelor up to 12 months
atorvostatin 80mg
ACEI - 10mg
Atenolol
ARB if heart failure