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Cardiology Disease Profiles > Acute Coronary Syndrome > Flashcards

Acute Coronary Syndrome Flashcards

1
Q

Why does acute coronary syndrome normally occur?

A

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

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2
Q

What are thrombi made up of mostly?

A

Platelets

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3
Q

Why are antiplatelet drugs useful in ACS?

A

Thrombi are made up of platelets

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4
Q

What does he right coronary artery supply?

A

RA
RV
Inferior aspect of the LV
Posterior septal area

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5
Q

Where is the circumflex artery?

A

Curves around the top, left and back of heart

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6
Q

What does the circumflex artery supply?

A

LA

Posterior aspect of the LV

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7
Q

Where does the LAD travel?

A

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

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8
Q

What does the LAD supply?

A

Anterior aspect of LV

Anterior aspect of the septum

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9
Q

Three types of ACS?

A

Unstable angina
NSTEMI
STEMI

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10
Q

How you diagnose a STEMI?

A

ST elevation

New left bundle branch block

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11
Q

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

A

Investigate troponin blood levels

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12
Q

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

A

NSTEMI

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13
Q

What would give the diagnosis of unstable angina?

A

Chest pain but normal troponin & no pathological changes

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14
Q

Symptoms of ACS?

A

Central constricting chest pain with

  • Nausea/vomiting
  • Sweating/clamminess
  • Feeling of impending doom
  • SOB
  • Palpitations
  • Pain radiating to jaw and arms
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15
Q

Should be concerned about ACS symptoms if?

A

They persist at rest for more than 20 mins

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16
Q

What is a silent MI?

A

Diabetic patients not experiencing typical chest pain for an MI

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17
Q

What would an ECG of a STEMI show?

A

ST elevation in leads consistent with ischaemia

New left bundle branch block

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18
Q 
What would an ECG of 
-ST depression in specific regions 
-Deep T wave inversion 
-Pathological Q waves 
indicate?
A

NSTEMI

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19
Q

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

A

Anterolateral

20
Q

Which leads does the left coronary artery show?

A

I, aVL, V3-6

21
Q

What artery corresponds to the anterior part of the heart?

A

LAD

22
Q

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

A

V1-4

23
Q

What does the circumflex correspond to?

A

Lateral part of the heart

Leads 1, aVL, V5-6

24
Q

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

A

Inferior

2,3, aVF

25
Q

What is troponin?

A

Protein found in cardiac muscle

26
Q

What does a diagnosis of ACS typically require?

A

Serial troponins 6 or 12 hours after onset

27
Q

What is a rise in troponin consistent with?

A

Cardiac ischaemia

28
Q

Alternative causes of raised troponin?

A 
Chronic renal failure 
Sepsis 
Myocarditis 
Aortic dissection 
Pulmonary embolism
29
Q

Investigations for ACS?

A 
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)
30
Q

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

A

Primary= PCI if available within 2 hours of presentation

If PCI not available= Thrombolysis

31
Q

What is thrombolysis?

A

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

32
Q

Cons of thrombolysis?

A

Significant risk of bleeding

33
Q

Agents for thrombolysis?

A

Streptokinase
Alteplase
tenecteplase

34
Q

Treatment for NSTEMI?

A

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

35
Q

Thing for remembering how to treat an NSTEMI?

A

BATMAN

36
Q

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

A 
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

37
Q

Complications of an MI?

A 
D- Death 
R- Rupture of heart septum/papillary muscles
E- oEdema (CHF)
A- Arrhyhmia &amp; aneurysm 
D- Dressler's syndrome
38
Q

How to remember complications of an MI?

A

DREAD

39
Q

Another term for Dressler’s syndrome?

A

Post MI syndrome

40
Q

When does Dressler’s syndrome occur?

A

2-3 weeks after an MI

41
Q

Why does dressler’s syndrome occur?

A

Caused by localized immune response & causes pericarditis

42
Q

How does Dressler’s syndrome present?

A

Pleuritic pain, low grade fever, pericardial rub on auscultation

43
Q

What can post MI syndrome cause?

A

Pericardial effusion

Pericardial tamponade

44
Q

How to diagnose Dressler’s syndrome?

A

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

45
Q

Management of Post MI syndrome?

A

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

46
Q

Prevention of secondary medical management of ACS?

A

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

47
Q

How many types of MI?

A

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

Cardiology Disease Profiles (12 decks)

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