Central constricting chest pain with - Nausea/vomiting - Sweating/clamminess - Feeling of impending doom - SOB - Palpitations - Pain radiating to jaw and arms

Acute Coronary Syndrome Flashcards by Charis Gibson

Why does acute coronary syndrome normally occur?

Result of a thrombus from an atherosclerotic plaque blocking a coronary artery.

How well did you know this?

Not at all

Perfectly

What are thrombi made up of mostly?

Platelets

How well did you know this?

Not at all

Perfectly

Why are antiplatelet drugs useful in ACS?

Thrombi are made up of platelets

How well did you know this?

Not at all

Perfectly

What does he right coronary artery supply?

RA
RV
Inferior aspect of the LV
Posterior septal area

How well did you know this?

Not at all

Perfectly

Where is the circumflex artery?

Curves around the top, left and back of heart

How well did you know this?

Not at all

Perfectly

What does the circumflex artery supply?

Posterior aspect of the LV

How well did you know this?

Not at all

Perfectly

Where does the LAD travel?

The left anterior descending artery travels down the middle of the heart

How well did you know this?

Not at all

Perfectly

What does the LAD supply?

Anterior aspect of LV

Anterior aspect of the septum

How well did you know this?

Not at all

Perfectly

Three types of ACS?

Unstable angina
NSTEMI
STEMI

How well did you know this?

Not at all

Perfectly

How you diagnose a STEMI?

ST elevation

New left bundle branch block

How well did you know this?

Not at all

Perfectly

What do you do next if there is no ST elevation?

Investigate troponin blood levels

How well did you know this?

Not at all

Perfectly

If there is increased troponin or other ECG changes (ST depression/T wave inversion/Path Q waves)?

NSTEMI

How well did you know this?

Not at all

Perfectly

What would give the diagnosis of unstable angina?

Chest pain but normal troponin & no pathological changes

How well did you know this?

Not at all

Perfectly

Symptoms of ACS?

Central constricting chest pain with

Nausea/vomiting
Sweating/clamminess
Feeling of impending doom
SOB
Palpitations
Pain radiating to jaw and arms

How well did you know this?

Not at all

Perfectly

Should be concerned about ACS symptoms if?

They persist at rest for more than 20 mins

How well did you know this?

Not at all

Perfectly

What is a silent MI?

Diabetic patients not experiencing typical chest pain for an MI

How well did you know this?

Not at all

Perfectly

What would an ECG of a STEMI show?

ST elevation in leads consistent with ischaemia

New left bundle branch block

How well did you know this?

Not at all

Perfectly

What would an ECG of 
-ST depression in specific regions 
-Deep T wave inversion 
-Pathological Q waves 
indicate?

NSTEMI

How well did you know this?

Not at all

Perfectly

What part of the heart does the Left coronary artery relate to?

Anterolateral

Which leads does the left coronary artery show?

I, aVL, V3-6

What artery corresponds to the anterior part of the heart?

LAD

Which leads show the anterior part of the heart/LAD?

V1-4

What does the circumflex correspond to?

Lateral part of the heart

Leads 1, aVL, V5-6

What do leads 2,3, aVF correspond to? Part of the heart & artery?

Inferior

2,3, aVF

What is troponin?

Protein found in cardiac muscle

What does a diagnosis of ACS typically require?

Serial troponins 6 or 12 hours after onset

What is a rise in troponin consistent with?

Cardiac ischaemia

Alternative causes of raised troponin?

``` Chronic renal failure Sepsis Myocarditis Aortic dissection Pulmonary embolism ```

Investigations for ACS?

``` All the ones for stable angina: -Physical exam -ECG -FBC -U&Es -LFTs -Lipid profile -HbA1C & fasting glucose -Thyroid function + Chest x-ray (for pulm oedema) Echocardiogram (assesses heart damage) CT coronary angiogram (Assess c artery disease) ```

Treatment of a STEMI if presenting with 12 hours of onset?

Primary= PCI if available within 2 hours of presentation | If PCI not available= Thrombolysis

What is thrombolysis?

Injecting fibrinolytic medication which breaks down fibrin, that rapidly dissolves clot.

Cons of thrombolysis?

Significant risk of bleeding

Agents for thrombolysis?

Streptokinase Alteplase tenecteplase

Treatment for NSTEMI?

B- Beta blockers A- Aspirin 300mg stat dose T- Ticagrelor 180mg (or clopidogrel 300mg) M- Morphine titrated for pain A- Anticoags: Low molecular weight heparin @ treatment dose N- Nitrates (GTN) to relieve coronary artery spasm

Thing for remembering how to treat an NSTEMI?

BATMAN

Risk assessment to assess if PCI is necessary for a NSTEMI?

``` GRACE score -gives the 6 month risk of death or repeat MI after NSTEMI <5%= low 5-10%= Medium >10%= High ``` Consider high and medium for a PCI

Complications of an MI?

``` D- Death R- Rupture of heart septum/papillary muscles E- oEdema (CHF) A- Arrhyhmia & aneurysm D- Dressler's syndrome ```

How to remember complications of an MI?

DREAD

Another term for Dressler's syndrome?

Post MI syndrome

When does Dressler's syndrome occur?

2-3 weeks after an MI

Why does dressler's syndrome occur?

Caused by localized immune response & causes pericarditis

How does Dressler's syndrome present?

Pleuritic pain, low grade fever, pericardial rub on auscultation

What can post MI syndrome cause?

Pericardial effusion | Pericardial tamponade

How to diagnose Dressler's syndrome?

ECG (global ST elevation & T wave inversion) Echocardiogram - pericardial effusion Raised inflammatory markers (CRP/ESR)

Management of Post MI syndrome?

NSAIDS: aspirin/ibuprofen Steroids: severe cases (prednis) Pericardiocentesis: removes fluid from around the heart if necessary

Prevention of secondary medical management of ACS?

6 As Aspirin - 75mg daily Another anti-platelet- clopidogrel/tecagrelor up to 12 months Atenolol- or other B blocker titrated as high as tolerated ACE Inhibitor- Ramipril titrated as tolerated up to 10mg daily Atorvastatin- 80mg daily Aldosterone antagonist- for those with CHF

How many types of MI?

5 1: traditional MI due to AC event 2: Ischaemia secondary to increased demand/reduced supply 3: Sudden cardiac death/arrest suggestive of ischaemic event 4: MI associated with procedures such as PI, coronary stenting or CABG