Acute Coronary Syndrome ACS

Question 1

What is Acute Coronary Syndrome (ACS)?

Answer 1

Acute Coronary Syndrome is an umbrella term for a range of conditions associated with sudden, reduced blood flow to the heart, typically including unstable angina, NSTEMI, and STEMI.

Question 2

What are the likely symptoms of ACS?

Answer 2

Chest pain, often described as crushing or tight, radiating to the left arm, neck, or jaw, dyspnoea, nausea, diaphoresis, and palpitations.

Question 3

What is the typical aetiology of ACS?

Answer 3

ACS is most commonly caused by atherosclerotic plaque rupture with subsequent thrombosis, leading to partial or complete coronary artery occlusion.

Question 4

What is the pathophysiology of ACS?

Answer 4

It involves plaque rupture, platelet activation, and thrombus formation, leading to ischaemia or infarction of myocardial tissue.

Question 5

What is the prevalence of ACS in the UK?

Answer 5

ACS is a leading cause of hospital admissions, with thousands of cases reported annually, particularly affecting older adults and those with cardiovascular risk factors.

Question 6

What are common risk factors for ACS?

Answer 6

Hypertension, smoking, diabetes, hyperlipidaemia, obesity, sedentary lifestyle, and a family history of cardiovascular disease.

Question 7

What clinical examination findings might suggest ACS?

Answer 7

Tachycardia, hypotension or hypertension, diaphoresis, pallor, and signs of heart failure such as raised jugular venous pressure or pulmonary crackles.

Question 8

What investigations are used to diagnose ACS?

Answer 8

ECG, cardiac biomarkers like troponin, chest X-ray, echocardiography, and coronary angiography.

Question 9

What ECG changes are indicative of STEMI?

Answer 9

ST-segment elevation in contiguous leads or new left bundle branch block (LBBB).

Question 10

What ECG changes are typical of NSTEMI or unstable angina?

Answer 10

ST-segment depression, T-wave inversion, or non-specific changes without ST-elevation.

Question 11

What role do troponins play in ACS diagnosis?

Answer 11

Elevated troponin levels indicate myocardial injury, helping distinguish between NSTEMI and unstable angina.

Question 12

What are the differential diagnoses for ACS?

Answer 12

Pulmonary embolism, pericarditis, aortic dissection, pneumothorax, gastro-oesophageal reflux disease, and musculoskeletal chest pain.

Question 13

What is the initial management approach for suspected ACS?

Answer 13

ABCDE assessment, oxygen if hypoxic, nitrates for pain relief, aspirin, and consideration of P2Y12 inhibitors.

Question 14

What is the purpose of dual antiplatelet therapy (DAPT) in ACS?

Answer 14

To reduce thrombus formation and prevent further ischaemic events.

Question 15

What are the medical management options for NSTEMI?

Answer 15

Antiplatelets, anticoagulants (e.g., heparin), beta-blockers, and statins, with consideration of angiography within 24-72 hours.

Question 16

What surgical intervention might be required for STEMI?

Answer 16

Emergency percutaneous coronary intervention (PCI) or, in some cases, thrombolysis if PCI is unavailable.

Question 17

What conservative management strategies are recommended post-ACS?

Answer 17

Lifestyle modifications such as smoking cessation, diet changes, regular exercise, and weight management.

Question 18

What complications can arise from ACS?

Answer 18

Heart failure, arrhythmias, cardiogenic shock, myocardial rupture, and recurrent ischaemia.

Question 19

How is unstable angina different from NSTEMI?

Answer 19

Unstable angina presents with similar symptoms but lacks myocardial injury markers like elevated troponins.

Question 20

What is the role of beta-blockers in ACS management?

Answer 20

They reduce myocardial oxygen demand by lowering heart rate and blood pressure.

Question 21

When is thrombolysis indicated in ACS?

Answer 21

Thrombolysis is used for STEMI patients when PCI is not available within a reasonable timeframe.

Question 22

What lifestyle advice should be given to a patient post-ACS?

Answer 22

Avoid smoking, maintain a heart-healthy diet, engage in regular physical activity, manage stress, and adhere to prescribed medications.

Question 23

How can ACS be prevented in high-risk individuals?

Answer 23

Risk factor management through lifestyle changes, control of hypertension, diabetes management, statin therapy, and antiplatelet medications if indicated.

Question 24

What is the role of coronary angiography in ACS?

Answer 24

To identify the location and severity of coronary artery blockages and guide revascularisation strategies like PCI.

Question 25

Why is early recognition of ACS critical?

Answer 25

Early recognition and intervention reduce mortality and morbidity by limiting myocardial damage and preventing complications.