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Medical conditions > acute coronary syndrome (ACS) > Flashcards

acute coronary syndrome (ACS) Flashcards

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USMLE® Step 1 flashcards
1
Q

angina presentation

A

substernal type of chest pain radiating to the neck, face and left arm

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2
Q

angina cause

A

insufficient oxygen supply to the heart muscle leading to ischaemia often due to atherosclerotic plaque build-up in coronary arteries

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3
Q

decreased oxygen supply consequences (2)

A

decreased perfusion pressure and decreased arterial oxygen content

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4
Q

increased oxygen demand consequences (4)

A

increased heart rate, increased preload, increased afterload, increased contractility

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5
Q

coronary artery diseases

A

diseases affecting the heart and coronary blood vessels often due to atherosclerosis and hypertension

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6
Q

CAD divisions (2)

A

stable angina and ACS

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7
Q

ACS divisions

A

unstable angina, NSTEMI, STEMI

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8
Q

stable angina pathology

A

stable fixed plaque covered by fibrous tissue

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9
Q

unstable angina pathology

A

plaque rupture and platelet aggregation

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10
Q

non-ST segment elevation myocardial infarction (NSTEMI) pathology

A

partial or incomplete blockage of coronary artery with plaque rupture

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11
Q

ST segment elevation myocardial infarction (STEMI) pathology

A

complete blockage of coronary artery often due to other precipitant with plaque rupture

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12
Q

CAD risks (6)

A

smoking, advanced age, diabetes, cholesterol, hypertension, family history

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13
Q

CAD symptoms (4)

A

angina, epigastric abdominal pain, nausea, diaphoresis

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14
Q

CAD diagnosis

A

12 lead ECG and cardiac biomarker test (troponins, CK-MB)

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15
Q

stable angina diagnosis

A

normal ECG during rest and T-wave inversion and/or ST depression during stress and negative troponin; obtain coronary angiogram for localising lesion

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16
Q

stable angina first line of treatment (5)

A

aspirin, beta blockers, calcium channel blockers, GTN, statins

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17
Q

stable angina second line of treatment

A

revascularisation

18
Q

when to give second line of treatment for stable angina (3)

A

positive stress test, high risk lesions, ineffective therapy

19
Q

revascularisation therapies

A

PCI/CABG and dual anti-platelet for a year

20
Q

coronary angioplasty or PCI

A

catheter inserts balloon or stent to widen coronary artery (not used for LCA occlusion)

21
Q

coronary artery bypass graft (CABG)

A

uses graft from other vessels to bypass lesion

22
Q

unstable angina diagnosis

A

T-wave inversion and/or ST depression and negative troponin

23
Q

NSTEMI diagnosis

A

T-wave inversion and/or ST depression and positive troponin

24
Q

unstable angina or NSTEMI first line of treatment (6)

A

BATMAN = beta blockers, aspirin, dual anti-platelet therapy (+ heparin), morphine, statins, GTN

25
Q

unstable angina or NSTEMI second line of treatment

A

revascularisation

26
Q

when to give second line of treatment for unstable angina or NSTEMI (4)

A

TIMI score>3, cardiogenic shock, ventricular fibrillation, ineffective therapy

27
Q

STEMI diagnosis

A

ST-segment elevation and positive troponin

28
Q

vasospastic angina diagnosis

A

ST-segment elevation and negative troponin

29
Q

STEMI first line of treatment

A

MONA = morphine, oxygen, GTN, aspirin; revascularisation (primary PCI or thrombolysis), ACE-Is, beta blockers, dual anti-platelet therapy, GTN, statins

30
Q

reasons for using primary PCI

A

within 12 hours of symptom onset and will achieve repercussion within 90 mins arrival to ED; for patients meeting ECG criteria for urgent reperfusion

31
Q

reasons for using thrombolysis

A

6-12 hours of symptom onset and will achieve repercussion within 90 mins arrival to ED if primary PCI is unavailable

32
Q

STEMI second line of treatment (6)

A

ACE-Is, aldosterone antagonists, aspirin and another anti-platelet, atenolol, atorvastatin

33
Q

non-pharmacological secondary preventions

A

limited alcohol, diabetes and hypertension control, diet and weight modifications, increased exercise, smoking cessation

34
Q

primary PCI benefits

A

faster as does not administer fibrinolytic agents or GPIIb/IIIa inhibitors

35
Q

rescue PCI

A

used if thrombolysis is not successful

36
Q

pharmaco-invasive PCI

A

used 3-24 hours after thrombolysis

37
Q

late pCI

A

used 12-24 hours in patients with ongoing ischaemia

38
Q

myocardial infarction complications (4)

A

arrhythmia, acute heart failure, pericarditis, rupture syndrome

39
Q

arrhythmia complications (3)

A

bradycardia, ventricular tachycardia, sudden cardiac death

40
Q

acute heart failure complications (2)

A

multi-system organ failure and hypoxia or dyspnea

41
Q

pericarditis complications

A

pleuritic chest pain and/or friction rub

42
Q

rupture syndrome complications (3)

A

heart failure, cardiac tamponade, stroke

Medical conditions (4 decks)

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