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CARDIOLOGY > [acute coronary syndrome]+[STEMI Mx] > Flashcards

[acute coronary syndrome]+[STEMI Mx] Flashcards

1
Q
A

STEMI
NSTEMI
unstable angina

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2
Q
A

STEMI

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3
Q
A

disruption of vulnerable/high risk plaque
leading to platelet activation–> thrombus
disrupted blood flow/occlusion
ischaemia

(can be due to vasculitides/spasm)

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4
Q
A

increased perspiration

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5
Q
A

1st degree relative

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6
Q
A

relaxed
unaffected by winning/losing
etc.

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7
Q
A 
ambitious
sensitive
stressed 
workaholic 
etc
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8
Q
A

modifiable
non-modifiable
controversial

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9
Q
A

increasing age
male gender
family Hx of IHS (see criteria)

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10
Q
A

cocaine

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11
Q
A 
DM
hypertension
hyperlipidaemia
obesity 
sedentary lifestyle 
smoking
cocaine use
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12
Q
A

ACE

angiotensin converting enzyme

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13
Q
A

DD-ACE

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14
Q
A

CK-MB ( CK cardiac isoenzyme)
AST (aspartate transaminase)
LDH (Lactate dehydrogenase)
Trop (Cardiac troponin)

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15
Q
A

CK-BB (CK brain)
CK-MM (skeletal muscle- up post trauma/exercise/myositis/hypothyroid/afrocaribs)
CK-MB (cardiac )

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16
Q
A

3-12 hours

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17
Q
A

within 24 hours

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18
Q
A

48-72 hours

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19
Q
A

afro-caribbean

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20
Q
A 
aortic dissection 
GO reflux
pericarditis
myocarditis
PE
angina
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21
Q
A

3

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22
Q
A

I

T

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23
Q
A

Muscle contraction from cardiac or skeletal muscle (NOT SMOOTH MUSCLE)

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24
Q
A

troponin I

troponin t

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25
Q
A

3-12 hours

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26
Q
A

24-48 hours

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27
Q
A

5-14 days

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28
Q
A

very unspecific

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29
Q
A

controversial

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30
Q
A

an increase followed by decrease in cardiac biomarkers
+ one of:

symptoms of ischaemia
ECG changes of new ischaemia
pathological Q waves
loss of myocardium on imaging

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31
Q
A

previous MI

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32
Q
A

symptoms of ischaemia
ECG changes of new ischaemia
pathological Q waves
loss of myocardium on imaging

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33
Q
A

the elderly

diabetics

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34
Q
A

acute chest pain (>20 mins)

palpitations

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35
Q
A

20 minutes

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36
Q
A 
epigastric pain
vomiting 
syncope
pulmonary oedema
stroke
confusion
DM hyperglycaemic states
post-operative hypotension
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37
Q
A

high OR low!

38
Q
A 
raised JVP
anxiety 
pallor 
sweatiness
low grade fever 
pulmonary oedema
40
Q
41
Q
A

perspiration

nausea

42
Q
A

raised JVP

pulmonary oedema

43
Q
44
Q
A

LDH-1 (found in the heart)

LDH-2 (found in the serum)

45
Q
A

a high LDH-1:LDH-2 ratio

46
Q
47
Q
A

hyperacute T waves

ST elevation or LBBB

48
Q
A

inverted T waves

pathological Q waves

49
Q
A

> 25% of the depth of the QRS complex

50
Q
A

no 20% are normal initially

51
Q
A

widened mediastinum

52
Q
A

widened mediastinum
pulmonary oedema
cardiomegaly

53
Q
A

symptoms settle
no ST elevation
no rise in troponin after 6 hours

54
Q
A

call an ambulance

55
Q
A 
aspirin 300mg chewed (if no absolute CIs)
\+
GTN (sublingual) (not in STEMI)
\+
morphine 5-10mg IV
\+
metoclopramide 10mg IV
56
Q
A 
bleeding disorder (haemophilia/vWF)
recent GI/intracranial bleed
salicylate allergy
Renal failure
liver failure
57
Q
A

increased risk of bleeding due to thrombolysis

58
Q
59
Q

[ACS]: Mx: STEMI: what 3 thing will you do ‘before’ any drug adminstration?

A

12 lead ECG initiated
IV access
assessment

60
Q
A

STEMI/NSTEMI determines treatment pathway

61
Q
A

Blood tests

IV drug administration

62
Q
A 
FBC
U+Es
Cardiac enzymes (troponin IT)
lipids
glucose
63
Q
A

Risk factor assessment for CVD/IHD (inc. familyHx)
Examination
CIs to PCI or fibrinolysis

64
Q
A 
aspirin 300mg PO
\+
morphine 5-10mg IV
\+
metoclopramide 10mg IV
65
Q
A

less than 95%

66
Q
A

left ventricular failure

67
Q
A

hypertensive

acute LVF

68
Q
69
Q
A

PCI (+bivalirudin) (percutaneous coronary intervention - angioplasty)
thrombolysis

70
Q
A

before - allows for easier Hx taking - vital!

71
Q
A

coronary angioplasty - balloon inserted and inflated

72
Q
A

patients can be at a primary PCI (+bivalirudin) centre within 120 minutes of FIRST MEDICAL CONTACT (paramedic/GP/morphine)

73
Q
A

fibrinolysis

74
Q
A

less than 30 minutes

75
Q
A

ST elevation >1mm in 2 or more limb leads
or
ST elevation >2mm in 2 or more chest leads
+
new onset LBBB (i.e. no prior pathology)
+
posterior changes (ST depression+tall R in V1-V3)

76
Q
A

Deep ST depression

Tall R waves in leads V1, V2 and V3

77
Q
A

> 24 has passed from onset of chest pain

78
Q
A

fibrinolysis post ECG confirmation of STEMI

79
Q
A

PCI (+bivalirudin) if fibrinolysis unsuccessful

angiography if successful

80
Q
A

bivalirudin

81
Q
A

DTI (direct thrombin inhibitor)

82
Q
A

recurrent ischaemia is common

83
Q
A

pericarditis

84
Q
A

increased risk of bleeding

85
Q
A 
previous intracranial haemorrhage
ischaemic stroke within 6 months
Cerebral AVM (/malignancy)
86
Q
A

non-compressible punctures (LP/liver biopsy)

recent major surgery (/trauma etc)

87
Q
A

bleeding disorder

88
Q
89
Q
A

GI (within 1 month)

cranial

90
Q
91
Q
A

Fondaparinux

CARDIOLOGY (11 decks)

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