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Cardiology > Acute Coronary Syndrome > Flashcards

Acute Coronary Syndrome Flashcards

1
Q

Identify three risk factors for ACS

A
  • Smoking
  • Hypertension
  • Diabetes
  • Obesity
  • Hypercholesterolaemia
  • Male gender
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2
Q

Identify three clinical features of ACS

A
  • Rapid onset chest pain that is severe and lasts longer than 15 minutes
  • Referred pain to arms, back or jaw
  • Dyspnoea
  • Sweating
  • Nausea
  • Vomiting
  • Pallor
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3
Q

How is STEMI diagnosed using ECG?

A
  • More than 1 mm ST elevation in at least two limb leads

- More than 2 mm ST elevation in at least two chest leads

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4
Q

Outline the evolution of the ECG in STEMI

A
  • ST elevation initially
  • Tall pointed T wave in first few minutes
  • T wave inversion and Q wave development in first few hours
  • ST segment returns to normal after a few days
  • T waves return to normal after a few days
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5
Q

Which leads demonstrate ST elevation in an anterior wall STEMI?

A
  • V1 - V3
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6
Q

Which leads demonstrate ST elevation in a lateral wall STEMI?

A
  • 1
  • aVL
  • V4-V6
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7
Q

Which leads demonstrate ST elevation in an inferior wall STEMI?

A
  • 2
  • 3
  • aVF
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8
Q

What is seen on an ECG in a posterior wall MI?

A
  • ST depression in V1-V3
  • Tall R wave in V1
  • ST elevation in V5 - V6
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9
Q

What is seen on an ECG inn an anterolateral wall MI?

A
  • ST elevation, Q waves, Inverted T waves

- Leads I, aVL, V2-V6

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10
Q

How do serum troponin levels change following MI?

A
  • Detectable after 3-6 hours
  • Peaked at 12-24 hours
  • Elevated for up to 2 weeks
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11
Q

Identify 3 other conditions that can raise troponins

A
  • Arrhythmia
  • Pericarditis
  • Pulmonary embolism
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12
Q

When and how is oxygen administered following a STEMI?

A
  • SpO2 < 94%
  • Simple face mask and flow rate of 5-10 L/min
  • Target oxygen saturations of 94-98%
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13
Q

Identify 2 medications that can be given to relieve pain following STEMI?

A
  • Intravenous diamorphine hydrochloride

- Sublingual GTN spray (3 doses) followed by IV GTN

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14
Q

Identify two initial medications administered following STEMI

A
  • Aspirin 300 mg

- Clopidogrel 300 mg

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15
Q

Why should patients undergo coronary angiography and PCI?

A
  • Prevent appearance of Q waves
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16
Q

When should coronary angiography and PCI be performed?

A
  • Within 12 hours of symptom onset

- Within 120 minutes of the time when fibrinolysis

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17
Q

Identify a medications that should be given to patients who are to undergo PCI

A
  • Unfractioned heparin
18
Q

When should fibrinolysis be administered?

A
  • Within 12 hours of symptoms onset

- When PCI cannot be deliveree within 120 minutes

19
Q

Identify two fibrinolytic agents

A
  • Alteplase

- Streptokinase

20
Q

Identify a contraindication to streptokinase

A
  • Previous streptokinase therapy
21
Q

Identify a medication used for patients who are ineligible for reperfusion therapy with either PCI or fibrinolysis

A
  • Fondaparinux sodium
22
Q

Identify two drugs to offer when the patient is haemodynamically stable

A
  • Ramipril

- Bisoprolol

23
Q

Identify a drug used in the management of STEMI in patients with heart failure and left ventricular dysfunction

A
  • Spironolactone
24
Q

Identify a program used for patients following a STEMI

A
  • Cardiac rehabilitation with an exercise component
25
Q

Identify three lifestyle changes following a STEMI

A
  • Diet consists of more fruit and vegetables, fish, and less meat, butter and cheese.
  • 20 - 30 minutes of moderate exercise daily
  • Smoking cessation
26
Q

How long should people wait before return to work post STEMI?

A
  • 2 months

- More time is needed for physically demanding jobs

27
Q

How long should people avoid sexual activity post STEMI?

A
  • 4 weeks
28
Q

How long should patients avoid air travel?

A
  • 2 months
29
Q

Identify three differential diagnoses of a STEMI

A
  • Unstable angina
  • NSTEMI
  • Aortic dissection
  • Pulmonary embolism
  • Pneumothorax
30
Q

What is found on ECG with NSTEMI?

A
  • T wave inversion greater than 1 mm in at least 2 leads
31
Q

What is found on ECG in unstable angina?

A
  • ST segment depression while the patient has pain
32
Q

What is the first line medication for NSTEMI and unstable angina?

A
  • Aspirin

- Clopidogrel if aspirin hypersensitivity

33
Q

What is the GRACE score?

A
  • Tool to assess risk of adverse cardiovascular event following NSTEMI or unstable angina
34
Q

Identify the management of a patient following NSTEMI or unstable who have a low risk of future adverse cardiovascular events based on the GRACE score

A
  • Dual anti-platelet therapy with aspirin and clopidogrel 300 mg
35
Q

Identify the management of a patient following NSTEMI or unstable who have a intermediate or high risk of future adverse cardiovascular events based on the GRACE score

A
  • Add intravenous eptifibatide or tirofiban
36
Q

When is coronary angiography and PCI considered in patients following NSTEMI or unstable angina?

A
  • Low risk patients if ischaemia is subsequently experienced or demonstrated
  • Intermediate or higher risk patients within 96 hours of admission
37
Q

Identify three adverse effects of aspirin

A
  • GI ulceration and haemorrhage
  • Bronchospasm
  • Tinnitus
38
Q

Identify three contraindications of aspirin

A
  • Children under 16 due to risk of Reye’s syndrome
  • Aspirin hypersensitivity
  • Third trimester of pregnancy
39
Q

Identify two adverse effects of clopidogrel

A
  • GI upset

- Thrombocytopenia

40
Q

Identify one contraindication of clopidogrel

A
  • Active bleeding

Cardiology (16 decks)

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