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Cardiology > Acute coronary syndrome (ACS) > Flashcards

Acute coronary syndrome (ACS) Flashcards

1
Q

What is the definition of acute coronary syndrome? [4]

A
  1. umbrella term for a spectrum of acute cardiac conditions -
  2. unstable (crescendo) angina
  3. ST-elevation myocardial infarction (STEMI)
  4. Non-ST-elevation myocardial infarction (NSTEMI)
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2
Q

What is the definition of MI? [1]

A

myocardial infarction means there is myocardial cell death, releasing troponin

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3
Q

What is the definition of ischaemia? [1]

A

lack of blood supply +/- cell death

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4
Q

What is unstable angina? [3]

A
  1. angina of recent onset (<24 hours) with increasing frequency or severity
  2. cardiac chest pain with crescendo pattern occurring with minimal exertion or at rest
  3. no rise in serum troponin
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5
Q

What is a STEMI? [4]

A
  1. complete occlusion of a major coronary artery
  2. full thickness damage to the myocardium
  3. usually diagnosed on ECG at presentation with ST elevation and pathological Q wave
  4. rise in serum troponin
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6
Q

What is an NSTEMI? [4]

A
  1. complete occlusion of major coronary artery / partial occlusion of minor coronary artery
  2. partial thickness damage to the myocardium
  3. usually a retrospective diagnosis with a rise in serum troponin
  4. ST-depression and T wave inversion, but no pathological Q wave
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7
Q

What are the 5 types of MI? [5]

A
  1. type 1 = spontaneous MI due to primary coronary event e.g. plaque rupture or dissection
  2. type 2 = MI secondary to ischaemia due to increased O2 demand or decreased supply e.g. coronary spasm, anaemia
  3. type 3 = MI due to sudden cardiac death
  4. type 4 = MI related to PCI
  5. type 5 = MI related to CABG
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8
Q

What is the incidence of STEMI in the UK? [1]

A

5/1000 per annum

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9
Q

What are the risk factors of ACS? [11]

A
  1. age - weaker endothelium and more time for plaque to develop
  2. male gender - oestrogen in protective?
  3. family history of IHD - MI in 1st degree relative <55 years
  4. smoking - damages endothelium
  5. hypercholesterolaemia - cholesterol is major risk factor
  6. obesity - more pericardial fat and increase in inflammation
  7. hypertension - added pressure on arterial walls
  8. diabetes - hyperglycaemia causes endothelial damage
  9. sedentary lifestyle
  10. cocaine use
  11. stress
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10
Q

What is the pathophysiology of ACS? [3]

A
  1. atherosclerotic plaque rupture in coronary artery
  2. leading to platelet aggregation and adhesion
  3. platelets release serotonin and thromboxane A2 resulting in myocardial ischaemia due to thrombus formation, vasoconstriction and reduction of coronary blood flow
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11
Q

What are the different stages of atherosclerosis/their clinical effect? [5]

A
  1. normal - clinically silent
  2. fatty streak - clinically silent
  3. fibrous plaque - angina / claudication / peripheral arterial disease
  4. atherosclerotic plaque - angina / claudication / peripheral arterial disease
  5. plaque rupture and thrombosis - MI / ischaemic stroke / critical leg ischaemia / sudden cardiovascular death
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12
Q

What are the symptoms of ACS? [6]

A
  1. unstable angina - chest pain, new onset, at rest with crescendo pain
  2. breathlessness
  3. pleuritic pain
  4. acute central chest pain lasting >20 mins
  5. associated with nausea, sweatiness, dyspnoea, palpitations
  6. may present without chest pain - silent myocardial infarction in diabetes
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13
Q

What are the signs of ACS? [8]

A
  1. distress and anxiety
  2. pallor
  3. sweatiness
  4. change in pulse
  5. change in BP
  6. 4th heart sound
  7. tachycardia/bradycardia
  8. peripheral oedema
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14
Q

What is the differential diagnosis of ACS? [5]

A
  1. pericarditis/myocarditis
  2. pulmonary embolism
  3. angina
  4. aortic dissection
  5. GORD
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15
Q

How is ACS diagnosed? [3]

A
  1. 12 lead ECG
  2. troponin levels
  3. chest x-ray
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16
Q

How can 12 lead ECG diagnose ACS? [4]

A
  1. can be normal
  2. ST depression and T wave inversion (NSTEMI)
  3. can get hyperacute T waves
  4. persistent ST elevation and hyperacute T waves (STEMI) with pathological Q wave
17
Q

How can troponin levels diagnose ACS? [3]

A
  1. troponin T and I are specific markers of myocardial necrosis
  2. serum troponin increases and peaks at 24-48 hours
  3. no rise in troponin in unstable angina
18
Q

How can chest x-rays diagnose ACS? [3]

A

look for -

  1. cardiomegaly
  2. pulmonary oedema
  3. widened mediastinum
19
Q

What are the treatment options of ACS? [7]

A
  1. pain relief with GTN spray and IV morphine (+ anti-emetic)
  2. oxygen recommended if <95% oxygen saturation
  3. aspirin
  4. P2Y12 inhibitors
  5. glycoprotein IIb/IIIa antagonists
  6. beta-blockers
  7. PCI
  8. CABG
20
Q

What is the action of aspirin? [3]

A
  1. COX inhibitor - irreversibly inactivates COX-1
  2. reduces prostaglandin synthesis including thromboxane A2 and reduced platelet aggregation
  3. side effects - gastric ulceration
21
Q

What is the action of and some examples of P2Y12 antagonists? [4]

A
  1. clopidogrel and ticagrelor
  2. inhibit ADP-dependent activation of glycoprotein IIb/IIIa so prevent amplification response of platelet aggregation
  3. used in combination with aspiring as dual-antiplatelet therapy
  4. side effects - increased risk of bleeding
22
Q

What is the action of and some examples of glycoprotein IIb/IIIa antagonists? [3]

A
  1. afciximab, tirofiban, eptifbatide
  2. used in combination with aspirin and P2Y12 inhibitors in patients undergoing PCI
  3. side effects - increases risk of major bleeding
23
Q

What is the action of and some examples of beta blockers? [4]

A
  1. bisoprolol, metoprolol, atenolol
  2. reduce heart rate, LV contractility and cardiac output so less oxygen demand
  3. do not give in - asthma, heart block/failure, bradycardia and hypotension
  4. side effects - tiredness, bradycardia, hypotension, nightmares, erectile dysfunction, cold hands and feet
24
Q

What is PCI? [3]

A
  1. percutaneous coronary intervention (PCI) involves inflating balloon and inserting stent into coronary artery to maintain wider artery and increase blood flow (coronary angioplasty)
  2. pros - less invasive, convenient, repeatbale
  3. cons - stent thrombosis, restenosis, not good for complex disease
25
Q

What is CABG? [3]

A
  1. coronary artery bypass graft - left internal mammary artery (LIMA) used to bypass proximal stenosis of left anterior descending (LAD) coronary artery
  2. pros - good prognosis, deals with complex disease
  3. cons - invasive, risk of stroke/bleeding, long recovery, can’t do if frail

Cardiology (5 decks)

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