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Cardiovascular system > Acute coronary syndromes > Flashcards

Acute coronary syndromes Flashcards

1
Q

What occurs in stable angina?

A

Fixed stenosis of the coronary arteries results in demand (due to exertion) led ischaemia, causing central chest pain

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2
Q

What are the 3 S’s of stable angina treatment?

A

Stop
Sit
Spray GTN

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3
Q

What are the 3 diseases that fall under the term ‘acute coronary syndrome’?

A

STEMI
NSTEMI
Unstable angina

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4
Q

What is meant by STEMI?

A

ST Elevation Myocardial Infarction

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5
Q

What is meant by NSTEMI?

A

Non ST Elevation Myocardial Infarction

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6
Q

What occurs in both a type I STEMI and NSTEMI?

A

Build up and rupture of an atherosclerotic plaque leads to occlusion of a coronary artery

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7
Q

What are some characteristics of vessels and plaques that make them more prone to rupturing?

A

Thickness of fibrous cap
Lipid content
Changes to intraluminal pressure
Bending and twisting of an artery
Plaque shape
Mechanical injury

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8
Q

What would occlusion of one of the left coronary artery branches lead to?

A

Left side fibrosis, leading to left sided heart failure

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9
Q

What are some symptoms of left sided heart failure?

A

Paroxysmal Nocturnal Dyspnoea
Cough
Orthopnoea
Exertional dyspnoea
Cyanosis
Blood tinged sputum
Elevated pulmonary capillary wedge pressure

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10
Q

What are some symptoms of STEMI?

A

History of severe, central, crushing chest pain that radiates to the jaw and arms (especially left)
Prolonged and not relieved by GTN spray
Can cause sweating, nausea and vomiting

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11
Q

What are some characteristics of a STEMI on ECG?

A

≥1mm ST elevation in 2 adjacent limb leads OR ≥2mm ST elevation in ay least 2 contiguous (Next to each other) precordial (Chest) leads
T wave inversion
Q waves
Left bundle branch block

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12
Q

How does the ECG of a person having a STEMI change over time?

A

First few hours = ST elevation
First day = Large Q wave formation
Long term = Inverted T waves may form

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13
Q

What ECG leads are inferior?

A

Lead II, III and aVF

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14
Q

Which ECG leads are anteroseptal?

A

V1-V2

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15
Q

Which ECG leads are anterior?

A

V3-V4

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16
Q

Which ECG leads are anterolateral?

A

V5-V6

17
Q

Which ECG leads are lateral?

A

I, aVL and aVR

18
Q

What can be seen on ECG in a left bundle branch block?

A

Broad QRS complexes >120ms with an inter-ventricular conduction delay, leading to a notched QRS which is very positive in the lateral leads

19
Q

What diagnostic test is used along side ECG to detect an MI?

A

Troponin

20
Q

What is the troponin test and what do the results show?

A

The troponin test tests for the presence of troponin I and troponin T, which are cardiac specific and are used to detect cardiac myocyte damage. A result greater than the 99th percentile is used to diagnose an MI

21
Q

What is the treatment option for a person with a STEMI, who is >120 minutes away from a PCI laboratory?

A

IV Diamorphine - analgesic
IV anti-emetic
GTN spray if BP >90mmHg systolic
Oxygen if hypoxic
300mg aspirin (Chewed) + either:
180mg ticagrelor
60mg prasugrel
300mg clopidogrel
Possible Fondaparinux/LMW heparin
ß-Blocker
Then prehospital thrombolysis using tPA
Then PCI or monitoring at nearest PCI lab +/- GPIIbIIIa inhibitor

22
Q

What is the treatment option for a person with a STEMI, who is <120 minutes away from a PCI laboratory?

A

IV Diamorphine - analgesic
IV anti-emetic
GTN spray if BP >90mmHg systolic
Oxygen if hypoxic
300mg aspirin (Chewed) + either:
180mg ticagrelor
60mg prasugrel
300mg clopidogrel
Possible Fondaparinux/LMW Heparin
ß-Blocker
Then PCI (Percutaneous Coronary Intervention) +/- GPIIbIIIa inhibitor

23
Q

What are some arrhythmic complications of acute MI?

A

Ventricular fibrillation can occur which causes highly chaotic muscular contraction, leading to stasis. This can be treated using defibrillation (Direct Current Cardioversion)

24
Q

What are some structural complications that can arise due to acute MI?

A

Cardiac rupture
Ventricular septal defect
Mitral valve regurgitation
Left ventricular aneurysm formation
Mural thrombus +/- systemic emboli
Inflammation
Acute pericarditis
Dressler’s syndrome

25
Q

What are some functional complications of acute MI?

A

Acute ventricular failure
Chronic cardiac failure
Cardiogenic shock

26
Q

What are the 4 stages of the KILLIP classification of function MI complications?

A

I - No signs of heart failure - 6% mortality
II - Crepitations <50% lung fields - 17%
III - Crepitations >50% lung fields - 38%
IV - Cardiogenic shock - 81% mortality

27
Q

What are some things to look out for in routine observations of people who have had an acute MI?

A

cardiac monitoring
Pulse and blood pressure
Heart sound - especially added sounds
Murmurs - especially new murmurs
Pulmonary crepitations - subcutaneous emphysema

28
Q

What occurs in an NSTEMI?

A

Though there is occlusion of a coronary vessel, it is not a full occlusion
Platelets can break off from the thrombus and block smaller vessels downstream

29
Q

How is an NSTEMI diagnosed?

A

ECG and Troponin test

30
Q

What can be seen on the ECG of a person having an NSTEMI?

A

No ST elevation and possible ST depression

31
Q

What is Fondaparinux?

A

A Factor Xa inhibitor

32
Q

What calculation system is used to assess the immediacy of angioplasty in a person with an NSTEMI?

A

GRACE risk calculator

33
Q

What are some other possible causes of high cardiac troponin levels?

A

Congestive Coronary Failure
Hypertensive crisis
Renal failure
Pulmonary embolism
Sepsis
Stroke
Pericarditis
Myocarditis
Post arrhythmia

34
Q

What medication will be given in the event of an NSTEMI?

A

Aspirin 300mg (Chewed)
Fondaparinux/LMW Heparin
Ticagrelor 180mg or Clopidogrel 300mg
ß-Blocker
PCI +/- GPIIbIIIa inhibitor

35
Q

What is meant by a type II MI?

A

An MI caused by ischaemic imbalance caused by another disease progression other than atherosclerosis.

36
Q

What are the 2 types of causes of Type II MI?

A

Increased myocardial oxygen demand
Decreased myocardial oxygen flow

37
Q

What are some causes of increased myocardial oxygen demand that can lead to Type II MI?

A

Sustained tachycardia
Significant hypertension
Marked left ventricular hypertrophy
Hypertrophic cardiomyopathy
Valvular disease

38
Q

What are some causes of decreased myocardial oxygen flow that can lead to Type II MI?

A

Anaemia
Hypoxia
Respiratory failure
Bradycardia
Hypotension
Vasospasm
Coronary embolism

Cardiovascular system (45 decks)

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