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FINALS - CARDIO > acute coronary syndromes > Flashcards

acute coronary syndromes Flashcards

1
Q

what presentations does ACS cover

A

STEMI, NSTEMI, unstable angina

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2
Q

how is an NSTEMI differentiated from unstable angina

A

no rise in troponin + no ECG changes

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3
Q

basic pathophsiology of atherosclerosis

A

endothelial dysfunction –> oxidaisation + phagocytosis of LDLs –> foam cells –> fibrous capsule over plaque

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4
Q

how do fatty plaques lead to IHD

A

narrowing of coronary vessels // rupture –> occlusion

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5
Q

presentation ACS

A

central chest pain // radiate to jaw or left arm // heavy pain // sweating // SOB

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6
Q

invx for ACS

A

ECG + troponin

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7
Q

who is an atypical presentation of ACS more common in (ie less pain)

A

elderly, diabetics, women

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8
Q

inital mx for all ACS patients

A

aspirin 300mg // nitrates // O2 if sats <94% // Morphine if needed

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9
Q

when in ACS would nitrates need to be held

A

hypotensive

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10
Q

how is STEMI diagnosed

A

symptoms >20 mins + ECG features >2 mins in at least 2 leads

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11
Q

when is PCI considered for STEMI

A

first line if present within 12 hours and PCI can be delivered in 120 mins

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12
Q

what artery is accessed for PCI and what stent is used

A

radial > femoral // drug-eluting stent

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13
Q

what is done if PCI cannot be offered within 120 minutes

A

fibrinolysis

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14
Q

prior to PCI what antiplatelets are given

A

aspirin + prasugrel (if not on anticoag) or clopidogrel (if on anticoag)

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15
Q

what medication is given during PCI

A

heparin + bailout GPI

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16
Q

what mediation should be given at the same time as fibrinolysis in a STEMI

A

antithrombin eg dabigatran, faundiparux

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17
Q

when should an ECG be repeated after fibrinolysis + what should be done if symptoms persist

A

ECG after 60-90 mins –> PCI

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18
Q

when would PCI be considered in NSTEMI or unstable angina

A

if risk assessment = 3%> (eg GRACE assessment)

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19
Q

if PCI or angiography is not planned in NSTEMI/ unstable angina what drug should be given

A

antithrombin eg fondaparoux + (aspirin + tricagrelor)

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20
Q

which patients with NSTEMI/ unstable angina should recieve immediate angio (+/- PCI)

A

clinically unstable eg hypotensive

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21
Q

which patients with NSTEMI/ unstable angina should recieve angio (+/- PCI) within 72 hours

A

GRACE score >3%

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22
Q

for those at low risk after NSTEMI/ unstable angina, and LOW risk of bleeding, what conservative treatment is given

A

aspirin + ticagrelor

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23
Q

for those at low risk after NSTEMI/ unstable angina, and HIGH risk of bleeding, what conservative treatment is given

A

aspirin + clopidogrel

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24
Q

what does the Killip class determine

A

30 day mortality post MI

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25
Q

what is Killip class 1

A

no signs of heart failure

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26
Q

what is Killip class 2-3

A

2 = lung crackles // 3 = frank pulm oedema

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27
Q

what is killip class 4

A

cardiogenic shock (80% mortality)

28
Q

what 3 things make typical angina

A

constricting chest, neck, shoulder, jaw pain + exacerbated by exercise + relieved by GTN

29
Q

what makes atypical angina

A

2/3 things

30
Q

if clinical assessment not enough for stable angina, what is 1st line invx

A

CT coronary angio

31
Q

2nd and 3rd line invx stable angina

A

2nd = non invasive imaging (eg SPECT, echo, MRI) // 3rd = invasie

32
Q

2nd and 3rd line invx stable angina

A

2nd = non invasive imaging (eg SPECT, echo, MRI) // 3rd = invasie

33
Q

what initial mx should all patients presenting with chest pain get

A

GTN + 300mg aspirin

34
Q

what should all patients with stable angina be started on

A

aspirin + statin

35
Q

1st line drugs for stable angina

A

beta blocker or CBB (verapmil or diltiazem)

36
Q

if monotherapy not working what mx is done for stable angina

A

max dose monotherapy –> CCB + beta blocker

37
Q

if dual therapy is used in stable angina what CCB must be used

A

amlodopine or nifedepine (verapamil + BB –> heart block)

38
Q

if dual therapy cannot be tolerated in stable angina what drugs should be considered

A

long acting nitrate eg isosorbide mononitrate // ivabrandine // nicorandil

39
Q

what dosing is required with isosorbide mononitrates

A

asymmetric dosing so there is a nitrate free period of 10-14 hours to prevent tolerance

40
Q

what should all patiens with STEMI recieve

A

aspirin + tricagrelor/ clopidogrel (or prasugrel if going for PCI)

41
Q

what drug is given to STEMI patients during PCI

A

unfractionated heparin (if unsuitable LMW heparin)

42
Q

when is O2 given in a STEMI

A

<94%

43
Q

1st line mx STEMI

A

PCI within 2 hours

44
Q

what drug is given during thrombolysis

A

tissue plasminogen activator (tPa) eg alteplase

45
Q

contraindications to thrombolysis

A

active or recent haemorrhage // coag or bleeding disorders // brain tumur // recent stroke

46
Q

after an MI what drugs shuld all patients recieve (4)

A

dual antiplatelet (aspirin +…) // ACEi // BB // statin

47
Q

what antiplatelets are commonly given after a medically managed ACS

A

aspirin (lifelong) + tricegrelor (12 months)

48
Q

what antiplatelets are commonly given after a PCI managed MI

A

aspirin + tricegrelor (or prasufel) (12 months)

49
Q

what drug can be given post MI for patietns with HF and left ventricular dysfunction

A

eplerenone started 3-14 days after

50
Q

most common cause of death following an MI

A

v fib –> arrest

51
Q

what type of MI can cause bradyarrhythmias

A

inferior MIs

52
Q

when is pericarditis common post MI + symptoms

A

48 hours –> pericardial rub + effusion (ECHO)

53
Q

what is dresslers syndrome

A

2-6 weeks post MI –> fever, pleuritic pain, effusion, raised ESR

54
Q

how is dresslers syndrome managed

A

NSAIDs

55
Q

how would left ventricular aneurysm present afer an MI

A

persistent ST elavation + LV failure

56
Q

how would LV rupture present post MI

A

1-2 weeks later –> tamponade (raised JVP, pulsus paradoxus, reduced heart sounds)

57
Q

how would ventricular septal defect present post MI

A

1st week –> acute HF, pansystolic murmur (ECHO)

58
Q

how can acute mitral regurg occur post MI

A

ischaemia or rupture of papilliary muscle

59
Q

how can acute mitral regurg present

A

acute hypotension + pulmonary oedema

60
Q

how does a posterior MI present on an ECG

A

ST depression not elevation

61
Q

what ECG changes could indicate a STEMI

A

ST elevation or new LBBB

62
Q

what ECG changes could indicate a NSTEMI

A

ST depression // deep T wave inversion // pathological Q waves

63
Q

what leads + artery indicate an anteroseptal MI

A

V1-V4 + LAD

64
Q

what leads + artery indicate an inferior MI

A

II, III, aVF + right coronary

65
Q

what leads + artery indicate an anterolateral MI

A

V1-6, I, aVL (LAD)

66
Q

what leads + artery indicate an lateral MI

A

I, aVL, V5-6 (left circumflex)

67
Q

what leads + artery indicate an posterior MI

A

changes in V1-3 (orV7-9) (usually ST depression) // left circumflex or right coronary

FINALS - CARDIO (17 decks)

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