Acute Coronary Syndromes Flashcards

1
Q

name what happens when there is spontaneous plaque rupture and local thrombosis with degrees of occlusion

A

acute coronary syndromes

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2
Q

give four examples of acute coronary syndrome

A

> unstable angina
non-ST elevation myocardial infarction
ST elevation myocardial infarction
sudden cardiac death

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3
Q

describe the character of the patients chest pain

A
> site: retrosternal
> character: tight band
> radiation: neck, jaw, down the arms
> aggravating: exertion, motional stress
> relieving factors: incomplete improvement with GTN or physical rest
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4
Q

name some modifiable risk factors associated with ACS

A
> smoking
> diabetes mellitus
> hyperlipidaemia
> hypertension
> lifestyle
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5
Q

what would the typical history for unstable angina/ NSTEMI be?

A

progressive angina with increasing frequency and severity

NSTEMI there will often be myocardial ischaemic symptoms occurring during rest

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6
Q

what would you expect to see on the examination for an unstable angina/NSTEMI?

A

look unwell or completely fine and there are often no specific features to be found

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7
Q

what investigations should you carry out for an unstable angina or STEMI?

A

ECG

biomarkers

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8
Q

what would you expect to see on an ECG of an unstable angina or NSTEMI?

A

they may be normal but there is commonly a st-segment depression, transient st-segment elevation or a t wave inversion.
in unstable anginas the changes resolve after pain but in NSTEMI they tend to persist

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9
Q

what is used as a biomarker in acute coronary syndromes?

A

cardiac troponin

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10
Q

what would an elevated cTn suggest?

A

a high risk of adverse events

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11
Q

when are cTn levels elevated?

A

when there is compromise to myocyte intergrity

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12
Q

what is the MONA treatment?

A

Morphine
Oxygen
Nitro-glycerine
Aspirin

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13
Q

what anti-platelet therapy should all acute coronary syndrome patients receive?

A

both aspirin and ADP receptors blocker:
> clopidogrel
> prasugrel
> ticagrelor

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14
Q

name the anti-thrombotic therapy that acute coronary syndrome patients can be put on?

A

> intravenous in-fractured heparin

> low molecular weight heparin

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15
Q

what are the contraindications for using beta-blockers to treat acute coronary syndrome?

A

> asthma
acute left ventricular dysfunction
impaired atrioventricular nodal conduction

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16
Q

when are angiotensin converting enzyme inhibitors given in acute coronary syndromes?

A

if there is left ventricular dysfunction

17
Q

what non-medical therapy can be given to treat acute coronary syndrome?

A

coronary angiography and revascularisation by PCI or CABG

18
Q

what can plaque rupture lead to?

A

more complete thrombotic occlusion or coronary lumen and infarction of distal myocardium

19
Q

how can you increase the amount of myocardium that can be salvaged after a ST-elevated myocardial infarction?

A

by dissolving/removing the occlusive thrombus quickly

20
Q

what has been proven to be a superior treatment of ST-elevated myocardial infarction and why?

A

primary PCI (over fibrinolytic therapy) for al cause, cardiac mortality, recurrent MI and reduced risk of haemorrhagic stroke

21
Q

how quickly should you aim to begin fibrinolysis for a STEMI?

A

> 90 minutes from the patient calling for help

> 30 mins of hospital arrival

22
Q

how can the call to needle time of fibrinolysis be reduced?

A

pre-hospital fibrinolysis

23
Q

what can increase the risk of intra-cranial haemorrhage from fibrinolytic therapy?

A
> over 75 years
> female
> previous stroke
> low body weight
> SBP >160mmHg
> chronic kidney disease
24
Q

in what scenario is primary PCI the best course of treatment for a STEMI?

A
> door to balloon time = less than 90 mins
> less than three hr symptom onset
> cardiac shock
> high bleeding risk
> uncertain diagnosis
25
in what situation will thrombolysis the best course of treatment in a STEMI?
> door to balloon time is more than 90 mins | > less than a 3hr symptom onset
26
what treatment is used for secondary prevention after a STEMI?
``` > change in lifestyle > control co-morbidities > aspirin and clopidogrel for 1 year > beta-blockers > statins > angiotensin converting enzyme inhibitor ```
27
what in-patient investigations would be carried out for a STEMI?
> echo for myocardial dysfunction | > LV ejection fraction
28
what would you be looking for in an echo for myocardial dysfunction in a STEMI?
``` > size of wall motion abnormality > hypokinetic or akinetic > overall contractility > presence and degree of overall mitral regurgitation > presence of mural thrombus ```
29
how can an acute coronary syndrome lead to sudden cardiac death?
the atherthrombotic event causes acute myocardial ischemia and subsequent sufficient electrical disturbance to cause ventricular arrhythmia
30
describe ventricular fibrillation
it tends to rapidly deteriorate into asystole which is more difficult to restore cardiac output. defibrillation is the only effective treatment
31
how quickly does the chance of resuscitation success reduce?
it reduces 7-10% every minute