Acute Coronary Syndrome and Myocardial Infarction

Question 1

Define stable angina

Answer 1

Where the patient will have angina on exertion only

Question 2

Define unstable angina

Answer 2

Where the patient will have angina at rest

Question 3

What form of angina is unpredictable and often leads to MI

Answer 3

Unstable angina

Question 4

What are the two types of myocardial infarction ?

Answer 4

Non-ST elevated myocardial infarction

ST elevated myocardial infarction

Question 5

What causes a NSTEMI ?

Answer 5

This will occur if a coronary artery is partially occluded and often follows unstable angina.

Question 6

What causes a STEMI ?

Answer 6

This will occur if a coronary artery is completely occluded and can follow on from a NSTEMI

Question 7

What specific pathology can cause a STEMI and what factors can cause this?

Answer 7

Plaque rupture

Inflammation and stress

Question 8

What type of clinical indications would you look for in past medical history ?

Answer 8

Smoker/ex-smoker
Diabetes
Hyperlipidaemia 
Previous angina
Strong family history of heart disease

Question 9

What bio-marker can be found in the patient’s blood which will indicate cardiac stress or an MI ?

Answer 9

Troponin (cTn)

Question 10

What else can cause Troponin to be found in the blood stream ?

Answer 10

Sepsis

Question 11

Where is Troponin found within the heart ?

Answer 11

Troponin can be found on the thin filaments within the myocytes

Question 12

In a STEMI what is most likely to occur in the tissue of the heart ?

Answer 12

Infarct/myocyte death

Question 13

What complications are likely to arise post MI ?

Answer 13

Mechanical complications

Ventricular arrhythmia complications

Question 14

What type of mechanical issues can arise post MI ?

Answer 14

Wall rupture
Inter-ventricular septum rupture
Papillary muscle rupture

Question 15

What type of Ventricular arrhythmia complications can occur ?

Answer 15

Ventricular tachycardia

Ventricular fibrillation

Question 16

Describe the mechanism of action of thrombolytic therapy

Answer 16

Works to breakdown the thrombus

Turns Plasminogen into plasmin which breaks down the fibrin and fibrin in the clot.

Question 17

What are the two types of Fibrinolytic agents ?

Answer 17

Specific Fibrinolytic agents

Non-specific fibrinolytic agents

Question 18

Name 3 fibrin specific agents

Answer 18

1: Alteplase
2: Reteplase
3: Tenecteplase

Question 19

When would thrombolytic therapy be used ?

Answer 19

When PCI not suitable or outwith the time-frame for PCI

Question 20

What is the benefit of aspirin in patients with ischaemic heart disease ?

Answer 20

Aspirin inhibits platelet production (specifically inhibiting Thromboxane A2)

Question 21

What is the immediate first line treatment for those who present with NSTEMI ?

Answer 21

ABCDE and then MONA
Morphine
Oxygen
Nitroglycerine
Aspirin

Question 22

How does Clopidogrel treat ischaemic heart disease ?

Answer 22

Much like aspirin Clopidogrel will inhibit platelet synthesis:
Blocking the ADP recepto
Also irreversibly inhibits P2Y12 ADP which is key to platelet aggregation and crosslinking with fibrin.

Question 23

What is the name of the pathway that is blocked by Clopidogrel ?

Answer 23

GP IIb/IIIa pathway.

Question 24

Name 4 types of low molecular weight Heparin

Answer 24

1: Enoxaparin
2: Dalteparin
3: Tinzeparin
4: Fondaparinux

Question 25

How do Beta Blockers treat ischaemic heart disease ?

Answer 25

They competitively inhibit the effects of catecholamines on the heart which will lower heart rate and blood pressure and also myocardial contractility.