Acute coronary syndrome

Question 1

What usually causes ACS?

Answer 1

thrombus from an atherosclerotic plaque blocking a coronary artery

Question 2

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

Answer 2

platelets

Question 3

what arteries does the Left coronary artery become?

Answer 3

circumflex and left anterior descending

Question 4

What areas does the right coronary artery supply?

Answer 4

right atrium and ventricle
inferior aspect left ventricle
posterior septal area

Question 5

where does the circumflex artery supply?

Answer 5

left atrium

posterior aspect left ventricle

Question 6

LAD supplies?

Answer 6

anterior aspect left ventricle and septum

Question 7

Three types of ACS

Answer 7

non-stable angina
NSTEMI
STEMI

Question 8

Diagnosis - first thing to do and findings

Answer 8

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

Question 9

troponin levels

Answer 9

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

no raised = unstable angina or MSK pain

Question 10

Symptoms

Answer 10

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

Question 11

how long should symptoms last for MI?

Answer 11

atleast 20 mins - if not consider unstable angina

Question 12

silent MI - who to watch out for?

Answer 12

diabetics

Question 13

Heart area and artery

1. anterolateral
2. anterior
3. lateral
4. inferior

Answer 13

1. Left coronary artery
2. LAD
3. circumflex
4. right coronary artery

Question 14

What are troponins?

Answer 14

proteins found in cardiac muscle

Question 15

Non ACS causes of raised troponin

Answer 15

chronic renal failure 
sepsis 
myocarditis 
aortic dissection 
PE

Question 16

Additional investigations for MI above those for stable angina

Answer 16

CXR - pulmonary oedema
Echo - functional damage
CT coronary angiogram

Question 17

STEMI initial management

Answer 17

within 2 hours = primary PCI

PCI not available in 2 hours = thrombolysis

Question 18

thrombolysis

Answer 18

injection - break down fibrin to dissolve clots

Question 19

risk of thrombolysis and examples of names

Answer 19

bleeding

alteplase

Question 20

Acute NSTEMI treatment - BATMAN

Answer 20

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

Question 21

GRACE score

Answer 21

6 month risk of death or repeat MI

high risk = early PCI (>10%)`

Question 22

Complications of MI - DREAD

Answer 22

Death 
Rupture heart septum 
Edema 
Arrythmia/aneurysm
Dresslers syndrome

Question 23

dresslers syndrome

Answer 23

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

Question 24

how does dresslers syndrome present?

Answer 24

pleuritic chest pain, low grade fever and pericardial rub

can cause pericardial effusion and pericardial tamponade

Question 25

diagnosing and managing dresslers syndrome

Answer 25

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

Question 26

6 A's of secondary prevention

Answer 26

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