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Cardiovascular > Acute Coronary Syndromes > Flashcards

Acute Coronary Syndromes Flashcards

1
Q

What are the coronary arteries of the heart?

A

Right coronary artery
Left anterior descending coronary artery
Circumflex coronary artery
Left main coronary artery

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2
Q

What is acute coronary syndrome?

A

New onset of a collection of syndrome relating to a problem with coronary arteries
Causes myocardial ischaemia and if this is prolonged then leads to myocardial infarction

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3
Q

Describe stable angina?

A

Caused by stable coronary lesion
Predictable symptoms due to narrowing - chest tightness/ discomfort
Symptoms are relieved at rest

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4
Q

Describe the presentation of acute coronary artery syndrome?

A

Unstable coronary lesion
Unpredictable
May occur at rest
Includes myocardial infarction and unstable angina

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5
Q

What is included in coronary artery syndromes?

A

Unstable angina
Non-ST elevation myocardial infarction
ST elevation myocardial infarction - complete blockage of the artery

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6
Q

Describe unstable angina in term of the atheroma?

A

Unstable plaque which is disrupted
This causes platelets aggregation as fat exposed to blood

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7
Q

How do you detect cell death?

A

Positive cardiac biomarker
And one of: symptoms of ischaemia, new ECG changes, coronary problem on angiogram on biopsy and any other test showing change in cardiac damage

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8
Q

What does troponin show?

A

Is used as a specific biomarker
Allows contraction and if in bloodstream shows insult to cardiac

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9
Q

What are some non-coronary causes for rise in troponin levels?

A

Arrhythmia - stress on heart
Pulmonary embolism - causes strain
Cardiac contusion
Sepsis
Anaemia

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10
Q

When is evidence of MI seen?

A

Mismatch between cardiac blood supply and demand

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11
Q

What is type 1 MI?

A

Associated with ischaemia and due to primary coronary event - plaque erosion, rupture, fissuring and dissection

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12
Q

What is type 2 MI?

A

Imbalance in supply and demand of oxygen. Result of ischaemia but not from thrombosis ex. endothelial dysfunction or fixed atheroma

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13
Q

What could the history be of a patient with acute coronary syndrome?

A

Ischaemic sounding chest pain
May radiate to neck or arm
More of a discomfort or tightening rather than pain
Can be associated with nausea, sweating and SOB

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14
Q

What are some factors that increase cardiac risk?

A

Male, Age, Known heart disease, High blood pressure, High cholesterol, Diabetes, Smoker and Family history

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15
Q

What would you look for in an examination?

A

Unwell is STEMI, or may be completely fine
Often no features to find
Check HR and BP in both arms
Listen for murmurs and crackles in chest

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16
Q

What are key investigations to carry out?

A

ECG and blood tests

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17
Q

What does complete coronary occlusion look like on an ECG?

A

ST elevation initially
Later on Q waves

18
Q

What does partial coronary occlusion look like on an ECG?

A

ST depression - ischaemia
T wave inversion
May be normal
No Q waves

19
Q

What will a posterior MI look like on an ECG?

A

Will be opposite changes in the leads opposite those looking at that area - depression is seen instead of elevation
Can be if LCx artery is completely blocked

20
Q

What is the difference on investigations between unstable angina and NSTEMI?

A

NSTEMI will have elevated troponin levels and unstable angina will not

21
Q

What is reperfusion therapy?

A

Opening of blocked artery to restore flow
Mechanical - primary PCI
Pharmacological - strong blood thinner

22
Q

Explain PCI

A

Percutaneous Coronary Innervation - angioplasty and stenting
In cath lab with balloon and stents
Balloon compresses the plaque so stent can now be deployed

23
Q

What is the pharmacological option for STEMI?

A

Thrombolysis - very strong blood thinning medication
Can be given quickly and if not able for surgery

24
Q

What are the risks of thrombolysis?

A

Bleeding
So don’t give if recent stroke or previous intracranial bleed
Caution with recent surgery or sever hypertension

25
Q

What is the options for a patient with STEMI who can get to lab in 2 hours?

A

Transfer to cath lab for primary PCI
If not then thrombolysis then transfer

26
Q

What is the management for Unstable angina and NSTEMI?

A

Admit to hospital, ECG, Attach to cardiac monitor, Gain IV cannula access and give O2 only if levels low

27
Q

What is the treatment for ischaemic pain?

A

Glycerol trinitrate (GTN)
Opiates if continue pain so need pain killer

28
Q

Describe Glycerol trinitrate (GTN)

A

Vasodilator
Can give sublingual or IV
Wont help if artery is completely blocked

29
Q

Describe what opiates do?

A

Ex. morphine
Helps relieve anxiety and is a painkiller
Helps vasodilate which may have haemodynamic benefits

30
Q

What are some anti-platelets drugs given?

A

Aspirin
Plus one of these - Clopidogrel, Ticagrelor and Prasugrel

31
Q

What are some anti-coagulant drugs given?

A

Prevent formation of fibrin
Heparin
Fondaparinux
Usually given as injection

32
Q

Describe beta blockers

A

Reduce work of heart as reduce sympathetic drive
Beneficial acutely
Reduce long term CV risks

33
Q

Describe statins

A

Stabilises plaque and works independent of cholesterol level
Cholesterol lowering drug

34
Q

Describe an ACE inhibitor

A

Helps heart muscle recover and useful in loner term

35
Q

Should patients with NSTEMI have a coronary angiogram?

A

If have high risk features then benefit from early invasive treatment
Most get angiogram unless likely to be type II MI
Ideally do angiogram in 48hours

36
Q

What are the risk of PCI and coronary angiogram?

A

Bleeding from arterial site, MI, coronary perforation, emergency CABG, Stroke and the dye can affect function of kidneys

37
Q

When dies a patient need a coronary artery bypass graft?

A

Three vessel disease
Left main stem disease
Disease not amendable to PCI

38
Q

What is the management for ACS in hospital?

A

Keep attached to cardiac monitor for 24-48 hrs and listen for new murmurs or signs of heart failure
Start secondary prevention medications
Organise ECHO

39
Q

Describe ventricular fibrillation?

A

Arises from ventricles - beats faster and out of rhythm
Patients unresponsive very quickly

40
Q

What are some mechanical complication from post-MI?

A

Myocardial rupture
Acute ventricular septic defect
Mitral valve dysfunction

41
Q

Describe a myocardial rupture

A

Damage to myocardial wall and causes blood to get into pericardium causing tamponade
Fatal unless detected and drained

42
Q

Describe acute ventricular septal defect?

A

Damage to muscle - LV and RV
Flow from LV to RV and patient is very unwell

Cardiovascular (33 decks)

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