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Cardiovascular > Acute Coronary Syndromes > Flashcards

Acute Coronary Syndromes Flashcards

1
Q

What can cause acute coronary syndrome?

A

Unstable angina
Non-ST elevation myocardial infarction
ST elevation myocardial infarction

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2
Q

What are the possible physiological causes of acute coronary syndrome?

A

Atherosclerosis plaque rupture or erosion
Superimposed platelet aggregation and thrombosis
Vasospasm and vasoconstriction
Subtotal or transient total occlusion of vessel

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3
Q

What are the goals of ACS therapy?

A

Increase myocardial oxygen supply

Decrease myocardial oxygen demand

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4
Q

How is myocardial oxygen supply increased?

A

Through coronary vasodilation

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5
Q

How is myocardial oxygen demand decreased?

A

Decreased heart rate
Decreased blood pressure
Decreased preload or myocardial contractility

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6
Q

What is the most likely cause of ACS in patients with STEMI?

A

Coronary thrombus occluding the infarct artery

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7
Q

How are patients with STEMI treated?

A

If no percutaneous intervention within 2 hours then thrombolysis

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8
Q

How do thrombolytic agents work?

A

They convert plasminogen into plasmin, a natural fibrinolytic agent

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9
Q

What does plasmin do?

A

Lyses clots by breaking down the fibrinogen and fibrin

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10
Q

What are the two categories of fibrinolytics?

A

Fibrin-specific agents

Non-fibrin-specific agents

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11
Q

Name some fibrin-specific agents

A

Alteplase
Reteplase
Tenecteplase

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12
Q

Name a non-fibrin-specific agents

A

Streptokinase

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13
Q

When would thrombolytic agents not be used?

A 
Prior intracranial haemorrhage 
Known structural cerebral vascular lesion 
Known malignant intracranial neoplasm 
Ischaemic stroke within 3 months 
Suspected aortic dissection 
Active bleeding 
Bleeding diathesis 
Significant close-head/facial trauma within 3 months
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14
Q

What should be used with thrombolysis when possible?

A

Aspirin

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15
Q

If no STEMI what is the treatment of ACS?

A 
Aspirin 
Trigagrelor/Clopidogrel 
Fondapurinux/LMW heparin 
Intravenous nitrate 
Analgesia 
Beta blockers 
Statin 
Prasugrel 
G IIb IIIa receptor blocker
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16
Q

What is acute coronary syndrome?

A

Any sudden cardiac event suspected or proven to be related to a problem with the coronary arteries

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17
Q

What is the worse possible outcome of ACS?

A

Sudden cardiac death

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18
Q

What is the only type of ACS that is treated with thrombolytics?

A

STEMI

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19
Q

How is NSTEMI managed?

A 
Aspirin 
PCI 
CABG 
Heparin 
Fondaparinux 
Statins 
Beta blockers 
Clopidogrel 
Prasugrel 
Ticagrelor 
Ticlopidine 
Cilostazol 
G IIb IIIa receptor
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20
Q

Why are anti platelet agents important?

A

The formation of platelet aggregates are important in the pathogenesis of angina, unstable angina and acute MI

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21
Q

What does Aspirin do?

A

Aspirin is a potent inhibitor of platelet thromboxane A2 production

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22
Q

What does thromboxane do?

A

Stimulates platelet aggregation and vasoconstriction

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23
Q

When can Aspirin be used?

A

In acute MI
In unstable angina
In secondary prevention

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24
Q

What can happen at high dose aspirin?

A

GI bleed

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25
Q

Is high dose aspirin more effective than low dose?

A

No

26
Q

What does Clopidogrel do?

A

Inhibits ADP receptor activated platelet aggregation

Prodrug

27
Q

In preventative medicine what should Aspirin be taken with?

A

Clopidogrel

28
Q

If Clopidogrel is not available what can be used instead of it?

A

Prasugrel

29
Q

Give examples of low molecular weight heparins

A

Enoxaparin
Dalteparin
Tinzeparin
Fondaparinux

30
Q

Is Enoxaparin or Fondaparinux preferable?

A

Fondaparinux

31
Q

What do Glycoprotein IIb/IIIa receptor inhibitors do?

A

Block platelet aggregation by inhibiting fibrinogen binding to conformationally activated form of GPIIb/IIIa receptor

32
Q

What is the major adverse effect of Glycoprotein IIb/IIIa receptor inhibitors?

A

Bleeding

33
Q

When are beta blockers used?

A

In the treatment of MI

Secondary prevention in survivors of an acute MI

34
Q

Give examples of beta blockers.

A

IV atenolol

Metoprolol

35
Q

When should beta blockers be avoided?

A

In patients with symptoms possibly related to coronary vasospasm or cocaine use

36
Q

What causes a STEMi?

A

Complete coronary occlusion

37
Q

What causes a NSTEMI?

A

Partial coronary occlusion

38
Q

What is part of chromic ischaemic heart disease?

A

Stable angina

39
Q

What is the physical difference in a STEMI and NSTEMI?

A

Partial thickness damage of heart muscle in NSTEMI but full thickness damage of heart muscle in STEMI

40
Q

On an ECG what difference is there between NSTEMI and STEMI?

A

ST elevation

Q wave in STEMI

41
Q

What type of MI is a STEMI?

A

Transmural MI

42
Q

What type of MI is a NSTEMI?

A

Subendocardial MI

43
Q

How is an MI diagnosed?

A

Positive cardiac biomarkers
Symptoms of ischaemia
ECG changes
Evidence of coronary problems

44
Q

What are the non-cardiac cause of troponin rise?

A

Pulmonary embolism
Sepsis
Renal failure
Sub-arachnoid haemorrhage

45
Q

What are the different classes of MI?

A

Type 1, 2, 3, 4a, 4b and 5

46
Q

What are the possible causes of an MI?

A 
Coronary vasospasm 
Coronary dissection 
Embolism in coronary artery 
Inflammation of coronary arteries 
Radiotherapy to chest can cause fibrosis and stenosis of coronary arteries 
Plaque erosion, rupture or fissuring 
PCI related 
Stent thrombosis 
CABG related
47
Q

What are the different types of transmural MI?

A 
Inferior 
Anterior 
Lateral 
Posterior 
Septal
48
Q

What causes an inferior MI?

A

Total occlusion of the right coronary artery

49
Q

What causes an anterior MI?

A

Total occlusion of the left anterior descending coronary artery

50
Q

What causes a lateral MI?

A

Total occlusion of the circumflex coronary artery

51
Q

What are the possible reperfussion therapies?

A

Mechanical - PCI

Pharmacological

52
Q

What does GTN do?

A

Vasodilator

53
Q

What do opiates do?

A

Help relieve anxiety
Helps venodilate
Pain relief

54
Q

Give an example of an opiate

A

Morphine

55
Q

Give an example of a beta blocker

A

Bisoprolol

56
Q

Give an example of a statin

A

Simvastatin

57
Q

Give an example of an ACE inhibitor

A

Ramipril

58
Q

What are the risks of coronary angiography or angioplasty or stenting?

A 
Bleeding 
Blood vessel damage 
MI 
Coronary perfusion 
Stroke 
Dye can affect kidney - contrast nephropathy
59
Q

What are the complications that can follow an MI?

A 
Arrhythmia 
Mechanical 
Cariogenic shock 
Myocardial rupture 
Death
60
Q

What are the mechanical complications of an MI?

A

Valve dysfunction

Acute ventricular septal defect

61
Q

What therapy is required after PCI or CABG?

A

Dual anti-platelet therapy for 12 months

62
Q

What are the long term complications of PCI and CABG?

A

Increased risk of further MI

Cardiac failure

Cardiovascular (34 decks)

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