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Chemical Pathology > Acute Coronary Syndromes > Flashcards

Acute Coronary Syndromes Flashcards

1
Q

How are acute coronary syndromes classified using troponin and ECG (3)

A

• Unstable angina: N troponin, non specific ECG
• non St elevation mi: high troponin, St depression
• St elevation mi: high troponin, St elevation

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2
Q

What is the most specific and sensitive tests for acute coronary syndrome?

A

Specific: ECG
Sensitive: cardiac biomarkers

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3
Q

Treatment stemi?

A

Immediate reperfusion therapy of <12 hours since onset
• first choice PCI with stent
• if > 120 min delay expected start fibrinolytic treatment and transfer to PCI capable hospital

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4
Q

Name the 3 subunits of troponin and where it’s found

A

• Troponin i: binds tropomyosin to actin, found only in myocardium
• troponin t: bound to tropomyosin, only in myocardium
• troponin c: recruits calcium during contraction, nonspecific - cardiac and skeletal

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5
Q

How is acute myocardial infarction diagnosed? (4)

A

• Test only troponin in suspected Ami: most sensitive and accurate, cardio-specific, fast predictable kinetics in occlusive disease (start increasing within 1-2 hours of onset, peak 24 - 48 hours, normalise 7-14 days)
• use only a high sensitivity (HS-) troponin essay
• repeat trop test over several hours (serial testing- get baseline then repeat after 1-3h ) to determine if injury is occlusive (rise and fall pattern) or non occlusive (stable pattern)
= 50% change from baseline is diagnostic

Plus one of the following: symptoms ischaemia, new st-t changes or new lbbb, new q waves, imaging evidence new muscle loss / regional wall motion abnormality, coronary thrombus at angiography/ autopsy

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6
Q

Describe the troponin testing strategy algorithm in ACS

A

• First troponin < 15 → pain > 6 hours → discharge (unless high risk)
, → pain < 6 hours → repeat after 3 hours → change < 50% → discharge
→ > 50% → admit
• <53 → repeat after 3 hours → see above
• 53 - 100 → repeat after 3 hours → change <20% → discharge
→ > 20% → admit
• > 100 → admit

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7
Q

Name 2 pitfalls in troponin measurement

A

• Detect myocardial damage but can’t distinguish between injury mechanisms (occlusion, inflamm, toxic, traumatic)
• decreased troponin clearance in kidney failure, nb to monitor trends if s-creat > 200

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8
Q

Name 10 causes acute troponin elevation in absence of ACS

A

Heart diseases
•Pericarditis, endocarditis, myocarditis
• left ventricular hypertrophy
• tachy arrhythmia
Etc

Other
• hypotension/shock
• pulmonary embolism
• sepsis
• CKD
• strenuous exercise
• sympathomimetic drugs
• chemotherapy

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9
Q

What will troponin be in chronic myocardial injury?

A

Stable troponin elevation 50 - 100 ng/l

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10
Q

Name 5 conditions that are very high risk (>30.%) of CVS events according to Framingham

A

• Established atherosclerosis, ie cad, cerebrovascular disease, periph arterial disease
• type 2 diabetes
• type 1 diabetes with microalbuminuria or proteinuria
• genetic dyslipídemia ie familial hypercholesterol
• CkD (gfr < 60)

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11
Q

Describe the Framingham intervention strategies for low risk patients <3%

A
  • LDL < 1.8 : no lipid intervention
  • LDL 1.8-2.5: no lipid intervention
  • LDL 2.5-4.9: lifestyle intervention
  • LDL >4.9: lifestyle intervention, consider drug if uncontrolled
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12
Q

Describe the Framingham intervention strategies for moderate risk patients 15-30 %

A
  • LDL < 1.8 : lifestyle intervention
  • LDL 1.8-2.5: lifestyle intervention
  • LDL 2.5-4.9: lifestyle intervention, consider drug if uncontrolled
  • LDL >4.9: lifestyle intervention, consider drug if uncontrolled
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13
Q

Describe the Framingham intervention strategies for high risk patients 15-30%

A
  • LDL < 1.8 : lifestyle intervention, consider drug
  • LDL 1.8-2.5: lifestyle intervention, consider drug
  • LDL 2.5-4.9: lifestyle intervention and immediate drug intervention
  • LDL >4.9: lifestyle intervention and immediate drug intervention
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14
Q

Describe the Framingham interventions for very high risk patients >30%

A
  • LDL < 1.8 : lifestyle intervention, consider drug
  • LDL 1.8-2.5: lifestyle intervention and immediate drug intervention
  • LDL 2.5-4.9: lifestyle intervention and immediate drug intervention
  • LDL >4.9: lifestyle intervention and immediate drug intervention
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15
Q

What indicates severity of heart failure

A

NT-pro-BNP

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16
Q

How can NT-pro-BNP be used? (3)

A
  • diagnose: dyspnoea from cardiac origin (not other)
  • prognosis: severity HF
  • Monitor disease progression: medicine adjustment

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