Acute coronary syndrome (includes biomarkers)

Question 1

acute coronary syndrome definition

Answer 1

syndrome of reduction/occlusion to blood supply of the heart

Question 2

acute coronary syndrome ( 3 x diseases )

Answer 2

1. unstable angina 2. non ST elevation MI 3. ST elevation MI

Question 3

unstable angina ( 6)

Answer 3

1. ischaemia / chest pain at rest 2. 70% degree of stenosis 3. subendocardial ischaemia 4. normal biomarkers 5. normal ECG 6. can progress to STEMI/NSTEMI

Question 4

non ST elevation MI (6)

Answer 4

1. subendocardial infarction - infarction distally and ischemia proximal to artery supply 2. 80-90% stenosis 3. atherosclerotic plaque could rupture and thrombus may form 4. change in bio markers 5. ST segment depression 6. can progress to STEMI

Question 5

ST segment elevation

Answer 5

1. transmural infarction - necrosis of all layers of the heart 2. thrombus completely obstructs the coronary artery ( LAD -> RCA–> lEFT CIRCUMFLEX ) 3. change in biomarkers 4. ECG - ST segment elevation 5. Damage of papillary muscles - ischaemia can cause damage and result in mitral regurg/prolapse 6. Check for left bundle branch block - infarction of left septum of the heart where left bundle branch goes through ( V1 - W, V2 - M )

Question 6

Symptoms of Acute coronary syndrome (3)

Answer 6

1. Central crushing chest pain referred to C7 - T4 towards left arm and jaw 2. Diapheresis - sweating (sympathetic nervous system) 3. Nausea + vomiting (parasympathetic )

Question 7

Troponin

Answer 7

1. cTnT and cTnI ( more specific ) 2. elevated levels within the blood within 2 -4 ours 3. peaks at 18 - 24 hours 4. stays elevated for 10 - 14 days

Question 8

Cardiac troponins are raised in (7)

Answer 8

1. MI 2. HEART FAILURE 3. TRAUMA 4. HYPERTENSION 5. SEPSIS 6. MYOCARDITIS 7. PE

Question 9

Creatinine kinase

Answer 9

1. Creatinine Kinase (MB) is found in cardiac muscle 2. CK itself is non specific between muscle and brain 2.increase 4 - 6 hours 3. peak level 24 hours 4. remains elevated 2 - 3 days 3. helpful for reinfarction - happens in 10% of MI

Question 10

Myoglobin

Answer 10

1. increase in 1 hour 2. peak level 2 - 12 hours 3. persistence 24 - 36 hours

Question 11

ECG changes in an MI

Answer 11

1. ST segment elevation - immediately 2. Pathological Q wave + T wave inversion + ST elevation - 1 week later 3. Pathological Q wave remains - weeks to months sign of previous MI

Question 12

criteria for diagnosing MI (5)

Answer 12

1. detect cardiac biomarkers risking/falling and atleast one of the following 2. symptoms of ischaemia 3/ ECG changed ( new ST-W changes or new LBB) 4. Development of pathological Q wave in the ECG 5. Imaging shows loss of viable myocardium / new regional wall abnormality

Question 13

Management for ACS ( immediate )

Answer 13

1. M -orphine/ IV opions ( Pain relief) 2. Oxygen - if O2 sats < 93% 3. Asprin /Clopinagril - anti platelet 4. Nitrates - vasodilation and increase oxygen low to heart

Question 14

Anterior MI

Answer 14

1. V1 - V4 lead changes 2. Left anterior descending occluded

Question 15

Anteroapical

Answer 15

1. V3 - V4 2. Distal LAD

Question 16

Anteroseptal

Answer 16

1. V1 and V2 2. LAD

Question 17

Anterolateral MI

Answer 17

1. I, aVL, V5, V6 2. Circumflex artery

Question 18

Inferior MI

Answer 18

1. II, II aVF

Question 19

Treatment for MI

Answer 19

1. Gold standard - Primary PCI ( stent ) to allow muscle to be reperfused 2. Thrombolysis - break down clot in the aryert

Question 20

HEART SCORE

Answer 20

1. H istory (+2 - highly suspicious/+1 moderately sus/0 - non sus ) 2. ECG ( + 2 sig ST depression/1 - non specific/) 3. Age - +2 > 65/+1 45-65 4. Risk factors - Chol/HTN/DM/Smokers/Obesity 5. Troponin ( +2 3 x normal/ +1 1 -2 x normal )

Question 21

Management for ACS (non immediate )

Answer 21

1. Anti coagulant 2. Betal blockers 3. Ace inhibitors)

Question 22

(3) types of troponin

Answer 22

Question 24

What are (2) cardiac troponins?

Answer 24

Cardiac troponins: cTnT and cTnI -> they differ from skeletal muscle troponin structurally

*cTNI is more cardio-specific

Question 25

Possible causes of raise in cardiac troponin

Answer 25

• MI
• HF
• Trauma
• Hypertension
• Sepsis
• Hypothyroidism
• Renal impairments
• Myocarditis
• PE
• many others…

Question 26

What diagnosis are cardiac troponins used for?

Answer 26

ACS

Question 27

Diagnostic criteria of MI

Answer 27

Detection of change in cardiac biomarkers (raise of troponin) + at least one of the

following (evidence of myocardial ischaemia) :

• symptoms of ischaemia
• ECG changes indicative of new ischaemia (new ST-T changes or new LBBB)
• Pathological Q wave changes in ECG
• Imaging evidence of new loss of viable myocardium or new regional wall motion

abnormality