Acute Coronary Syndromes

Question 1

Describe the anatomy of coronary arteries.

Answer 1

Coronary arteries are blood vessels that supply the heart muscle with blood, with three main arteries on the left: left main stem, Left Anterior Descending (LAD), and circumflex, and one on the right: right coronary artery.

Question 2

What is Acute Coronary Syndrome (ACS)?

Answer 2

ACS refers to a new onset collection of signs or symptoms that lead to problems with the coronary arteries, causing myocardial ischemia due to inadequate blood supply to the heart muscle.

Question 3

Define myocardial infarction.

Answer 3

Myocardial infarction is the result of prolonged myocardial ischemia, leading to cell death in the heart muscle due to insufficient blood supply, often caused by coronary artery issues.

Question 4

How does stable angina differ from acute coronary syndrome?

Answer 4

Stable angina is caused by severe narrowing in a coronary artery, leading to predictable chest discomfort during exertion, while ACS involves unpredictable and unstable plaque conditions, often causing symptoms at rest.

Question 5

Describe the layers of a coronary artery affected by plaque formation.

Answer 5

The layers include the intima (internal layer), media (middle layer), and adventitia (outer layer), with plaques forming fatty material covered by a fibrous cap, which can differ in thickness and stability.

Question 6

What are some common symptoms of stable angina?

Answer 6

Common symptoms include chest tightness or discomfort during activities like walking uphill, which can be relieved by rest, indicating predictable chest discomfort related to exertion.

Question 7

Describe the process of how a blood clot can form in a blood vessel due to exposure to fatty material within plaque.

Answer 7

Platelets and fibrin can aggregate, forming a thrombus that can block the artery, leading to issues with blood supply.

Question 8

Define myocardial infarction and how it is detected.

Answer 8

Myocardial infarction is cardiac cell death, detectable through specific biomarkers like troponin found in the bloodstream.

Question 9

How is troponin used as a biomarker for myocardial cell damage?

Answer 9

Troponin is a specific marker for cardiac muscle damage, released into the bloodstream when there is injury to the myocardial cells.

Question 10

What are some causes of elevated troponin levels besides myocardial cell death?

Answer 10

Elevated troponin levels can result from stress on the heart, arrhythmia, pneumonia, cardiac contusions, or pulmonary embolism.

Question 11

Describe the significance of troponin elevation in relation to the mismatch between blood supply and heart demand.

Answer 11

Troponin elevation can indicate a mismatch between the blood supply to the heart and the demand, which may not necessarily be due to primary heart issues.

Question 12

Define the role of myoglobin and creatine kinase in detecting cardiac cell damage.

Answer 12

Myoglobin and creatine kinase, including the CK-MB isoform, were previously used as biomarkers for cardiac cell damage before troponin became the preferred marker.

Question 13

How can a myocardial infarction be diagnosed besides biomarker elevation?

Answer 13

A myocardial infarction can be diagnosed through symptoms of ischemia, ECG changes, evidence of coronary problems on tests like angiograms, or even post-mortem examinations.

Question 14

Describe the difference between Type one and Type two myocardial infarctions.

Answer 14

Type one MI involves a blockage in the coronary artery, while Type two MI is characterized by a supply-demand mismatch without a primary issue in the coronary artery.

Question 15

How can medications like cocaine or certain chemotherapy drugs contribute to a Type two myocardial infarction?

Answer 15

These medications can cause vasoconstriction of the coronary artery, leading to a supply-demand mismatch even if there is no underlying issue with the coronary arteries.

Question 16

Describe the presentation of Acute Coronary Syndromes.

Answer 16

Acute Coronary Syndromes typically present with chest pain, which can be challenging to differentiate from other causes of chest pain like lung issues, gastrointestinal problems, or muscle strain.

Question 17

Do elderly individuals with multiple health issues present differently with myocardial infarctions compared to young, fit individuals?

Answer 17

Yes, elderly individuals with multiple health issues may present with atypical symptoms and comorbidities affecting the diagnosis and management of myocardial infarctions.

Question 18

How does establishing a patient’s chest pain history help in diagnosing myocardial infarctions?

Answer 18

Taking a detailed history helps differentiate whether chest pain is ischemic or not, aiding in determining if the symptoms are related to a heart attack or another medical condition.

Question 19

Describe the symptoms of chest pain mentioned in the content.

Answer 19

Symptoms include discomfort, tightness, weight across the chest, radiating to the neck or arm, numbness, nausea, sweating, and breathlessness.

Question 20

Define the importance of taking a good history in diagnosing chest pain.

Answer 20

Taking a good history helps identify risk factors, associated features, and potential causes like pneumonia or ischemic heart disease.

Question 21

How is examination important in assessing patients with chest pain?

Answer 21

Examination involves checking for signs like appearance, heart rate, blood pressure, murmurs, crackles in the chest, and swollen ankles to assess cardiac function.

Question 22

What are the key investigations for patients presenting with chest pain?

Answer 22

Key investigations include a 12-lead ECG to assess heart’s electrical activity and blood tests to evaluate cardiac health.

Question 23

Describe the significance of ST segment in an ECG for ischemic heart diseases.

Answer 23

ST segment elevation indicates acute coronary artery occlusion, while ST depression and T wave changes suggest ischemia, aiding in the diagnosis of heart conditions.

Question 24

How can ECG findings help identify the location of a myocardial infarction?

Answer 24

ECG leads showing ST elevation in specific areas like anterolateral or inferior leads can indicate the affected artery, such as LAD or right coronary artery, aiding in prompt intervention.

Question 25

Describe the process of assessing patients presenting with chest pains suspected to be ischemic.

Answer 25

The key step is to rapidly obtain an ECG, where ST Elevation indicates an ST Elevation Myocardial Infarction.

Question 26

Define Reperfusion Therapy in the context of cardiac care.

Answer 26

It involves opening up blocked arteries to restore blood flow, commonly done through Primary PCI or thrombolytic medication.

Question 27

How does Primary PCI work in treating a heart attack?

Answer 27

It involves inserting a wire through the narrowed artery, inflating a balloon to clear plaque, and placing a stent to keep the artery open.

Question 28

What is Thrombolysis and when is it used in cardiac emergencies?

Answer 28

Thrombolysis is the administration of strong blood-thinning medication to dissolve blood clots, often used when Primary PCI is not immediately available.

Question 29

Describe the considerations and risks associated with administering thrombolytic medication.

Answer 29

Factors like recent bleeding issues, stroke, surgery, or high blood pressure must be weighed against the benefits of unblocking arteries to avoid potential bleeding complications.

Question 30

How does the timing of thrombolytic administration impact its effectiveness in treating a heart attack?

Answer 30

Thrombolysis is most effective when given within an hour or two of chest pain onset; delayed administration may reduce its success rate.

Question 31

Describe the importance of timely access to a cath lab in managing an occluded artery.

Answer 31

Timely access to a cath lab is crucial for establishing blood flow and minimizing damage in cases of an occluded artery.

Question 32

How should patients with ischemic chest pain but no ST Elevation be managed initially?

Answer 32

Patients should be admitted to the hospital, undergo serial ECGs, be monitored for heart rhythm, receive IV medications as needed, and have blood tests including high sensitivity troponin.

Question 33

Define the role of GTN (Glycerol trinitrate) in treating ischemic pain.

Answer 33

GTN is a vasodilator that relaxes coronary arteries, helpful in cases of tight narrowing or spasm, and can be administered under the tongue or as a continuous infusion.

Question 34

What are the primary goals of giving blood thinners in Acute Coronary Syndrome?

Answer 34

The primary goal of blood thinners is to prevent blood clotting within the coronary arteries by inhibiting platelet aggregation and fibrin formation.

Question 35

How can ECG monitoring help in the assessment of patients with suspected heart issues?

Answer 35

ECG monitoring can help detect evolving changes, assess for ST Elevation, and identify potential cardiac abnormalities in patients with suspected heart problems.

Question 36

Describe the significance of serial ECGs in the evaluation of patients with chest pain.

Answer 36

Serial ECGs are important to monitor for evolving changes, especially when initial ECG may not show abnormalities in patients with chest pain.

Question 37

What enzyme does aspirin inhibit?

Answer 37

COX-1

Question 38

Describe the action of P2Y12 receptor antagonists like Ticagrelor.

Answer 38

They prevent platelets from sticking together and forming blood clots.

Question 39

What is the role of GP IIb/IIIa inhibitors in the context of antiplatelet therapy?

Answer 39

They are potent antiplatelet drugs that prevent platelets from sticking together, particularly in acute situations.

Question 40

How do beta blockers benefit patients during a myocardial infarction?

Answer 40

They reduce the workload of the heart by decreasing sympathetic drive, providing acute and long-term benefits.

Question 41

Define the function of statins in the treatment of cardiovascular conditions.

Answer 41

Statins lower cholesterol levels and have additional actions that stabilize plaque, independent of cholesterol levels.

Question 42

What is the purpose of ACE inhibitors in heart muscle recovery?

Answer 42

They help the heart muscle recover and can be beneficial in the longer term to restore normal function.

Question 43

Do patients with non-ST Elevation Myocardial Infarctions typically undergo coronary angiograms?

Answer 43

Yes, especially those with high-risk features benefit from an early invasive strategy involving a coronary angiogram.

Question 44

How has the approach to angiograms evolved to reduce bleeding risks?

Answer 44

Nowadays, radial or ulnar artery access is preferred over the femoral route to minimize bleeding risks during angiograms.

Question 45

What is the purpose of undergoing PCI in some cases?

Answer 45

To determine if the benefits outweigh the risks.

Question 46

Describe the process of bypass surgery for coronary artery disease.

Answer 46

It involves taking veins or mammary artery to bypass narrowings or blockages in coronary arteries.

Question 47

How is Acute Coronary Syndrome managed post-heart attack?

Answer 47

By monitoring heart rhythms, checking for murmurs or signs of heart failure, starting appropriate medication, and conducting an echocardiogram.

Question 48

Define ventricular fibrillation and its implications.

Answer 48

It is a chaotic heart rhythm that can lead to sudden death if not treated promptly with defibrillation.

Question 49

What are the two main groups of complications post-myocardial infarction?

Answer 49

Arrhythmic complications and mechanical complications.

Question 50

Describe the mechanical complications that can occur post-heart attack.

Answer 50

They include issues like cardiac tamponade, acute ventricular septal defect, and mitral valve problems, which can be fatal if not promptly addressed.

Question 51

Describe the consequences of myocardial rupture.

Answer 51

Myocardial rupture can lead to blood leaking out of the heart into the pericardium, causing Tamponade which can be fatal.

Question 52

Define Acute Ventricular Septal Defect.

Answer 52

Acute Ventricular Septal Defect is when there is damage to the muscle between the left and right ventricle, causing blood flow from the LV to the RV.

Question 53

How does papillary muscle rupture affect the heart?

Answer 53

Papillary muscle rupture can lead to mitral valve regurgitation, causing breathlessness and the need for surgical intervention.

Question 54

What is the typical course following acute coronary syndrome in the hospital?

Answer 54

Patients are rapidly assessed, may undergo cath lab procedures, receive appropriate medications, and can often be discharged within a few days.

Question 55

Do cardiac rehabilitation nurses play a role in post-acute coronary syndrome care?

Answer 55

Yes, they provide advice on lifestyle changes, medication adherence, and arrange necessary follow-up for patients.

Question 56

Describe the importance of taking a good history in diagnosing Acute Coronary Syndromes.

Answer 56

Taking a good history is crucial in determining if chest pain is ischemic in origin and if the patient may be experiencing an Acute Coronary Syndrome.

Question 57

How can an ECG help in diagnosing Acute Coronary Syndromes?

Answer 57

An ECG can show ST Elevation, indicating a blocked coronary artery and the need for urgent intervention, or the absence of ST Elevation, allowing for further evaluation and management decisions.

Question 58

Define the significance of an elevated troponin level in Acute Coronary Syndromes.

Answer 58

An elevated troponin level indicates myocardial cell injury or insult, but does not necessarily confirm a major coronary problem, requiring consideration of various factors before deciding on interventions like an angiogram.