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CSB335 > Acute coronary syndromes > Flashcards

Acute coronary syndromes Flashcards

1
Q

What is the role of fibrin involved in clot formation?

A

Fibrin forms a mesh over wounds - this is the beginning of a clot

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2
Q

Name the two acute coronary syndromes

A

Unstable angina and acute myocardial infarction

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3
Q

What results in myocardial ischaemia?

A

Inbalance between myocardial blood supply and demand

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4
Q

What is the definition of angina pectoris?

A

Acute pain, usually in the chest, resulting from an increased oxygen and glucose demand but a decreased ability to provide it, usually due to a partially occluded coronary artery or vasospasm.

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5
Q

What is the typical presentation of angina pectoris?

A
  • Squeezing/crushing/heavy/tight chest pain
  • Fist to chest (Levine’s sign)
  • Pain/discomfort may radiate to shoulders/arms/
    neck/back/jaw/epigastrium
  • Usually lasts 3-5 min and rarely exceeds 15 min
  • Not changed by swallowing, coughing, deep breathing or positional changes
  • Anxiety
  • Diaphoresis or clammy skin
  • Nausea, vomiting
  • Shortness of breath
  • Weakness
  • Palpitations
  • Syncope
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6
Q

Is angina pectoris an acute or ischaemic coronary syndrome?

A

Ichaemic

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7
Q

What usually provokes angina pectoris?

A
  • Exercise
  • Eating
  • Emotion/Stress
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8
Q

What usually relieves angina pectoris?

A
  • Rest/removal of provoking factor
  • Nitrates
  • Aspirin
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9
Q

What is stable angina pectoris?

A
  • Reasonably predictable frequency, onset, and duration

- Relief predictable with rest/nitrates

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10
Q

What are the treatment goals for stable angina pectoris?

A
  • Reduce myocardial oxygen/glucose demand

- Improve myocardial blood supply

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11
Q

Describe the treatment of stable angina pectoris

A
  • Physical and psychological rest
  • Position of comfort (sitting or supine)
  • O2 only if indicated
  • Cardiac monitoring
  • GTN, aspirin, morphine/fentanyl, ondansetron
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12
Q

What are the indications for treating stable angina pectoris as AMI?

A
  • First time angina
  • Unstable angina
  • Angina requiring more than 3 GTN sprays (lasting longer than 15 minutes)
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13
Q

What is variant angina?

A

Angina that occurs at rest, is the result of coronary vasospasms, and is treated long term with calcium channel blockers

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14
Q

True or false: variant angina may result in abnormal 12 lead ECG changes that resolve with minimal treatment

A

True

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15
Q

What is the definition of unstable angina?

A

Prolonged chest pain/ischaemic symptoms or an atypical presentation of angina without evidence of AMI, usually associated with significant or progressing occusion of a coronary artery or severe vasospasm. It is considered ‘pre-infarction angina’.

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16
Q

Describe atypical presentation of unstable angina

A
  • Increased frequency or duration of episodes
  • Onset with less exertion than normal
  • Increased severity of symptos
  • Requires more GTN than usual to relieve symptoms
17
Q

Describe the treatment of unstable angina

A

Same as stable angina, with addition of:

  • IV access
  • 12 lead monitoring
  • Pain management as necessary
  • Other standard management by indication (ondansetron etc)
18
Q

What is acute myocardial injury?

A

Presentation of unstable angina or acute ischaemia with potential for myocardium salvage

19
Q

What is the definition of acute myocardial infarction?

A

Necrosis of myocardial tissue caused by a lack of oxygenation and blood flow resulting from an occluded coronary artery
AMI is also often used to describe acute injury when extent of necrosis is unknown but imminent

20
Q

What are the precipitating factors of AMI?

A
  • Coronary thrombosis (most common)
  • Coronary vasospasm
  • Microemboli
  • Severe hypotension/shock
  • Acute hypoxia
  • Acute volume overload
21
Q

What is the initiating event in most ischaemic coronary events?

A

Rupture of vulnerable plaque’s soft lipid core

22
Q

What does rupture of atheromatous plaque result in?

A

Thrombus formation

23
Q

A persistent thrombotic occlusion (2-4+ hours) may result in what?

A

Acute myocardial infarction

24
Q

Repeated thrombus formations may have what effect?

A

Further decrease lumen size

25
Q

What does intermittent non-occlusive thrombus formation result in?

A

Unstable angina

26
Q

What is the presentation of acute myocardial infarction?

A
  • Similar to angina but lasts longer and is not easily relieved with rest or GTN
  • Symptoms may be more severe (feeling of impending doom)
  • Pain often radiates to arms/neck/jaw/back/epigastrium
  • Some present atypically (complaints of only weakness or shortness of breath)
  • Dysrhythmias
  • Sudden cardiac death
27
Q

What are the Rx goals for AMI?

A
  • Rapid identification and dx
  • Decrease myocardial oxygen demand (remove stressors, relieve pain, reduce cardiac workload)
  • Inhibit further clot formation
  • Transport for reperfusion therapy
28
Q

Describe the management of AMI

A

Same as angina, plus:

  • IV fluids when indicated
  • 12 lead monitoring
29
Q

All pts with inferior elevation should be checked with what additional ECG view?

A

V4R

30
Q

How is a V4R ECG reading obtained?

A

Move V4 over to the R side and take another 12 lead; elevation indicates RV involvement, meaning the pt is preload dependent (which is a contraindication for GTN)

31
Q

What may increase the risk of misdiagnosis?

A
  • Elderly with atypical symptoms
  • Young pts with unsuspected AMI
  • LBBB
  • ALOC
  • Diabetics
  • Mental disorders
32
Q

STEMI dx requires confirmation of two of three criteria; name them

A
  • Hx
  • ECG changes
  • Elevation of serum levels of cardiac markers
33
Q

What is the definition of sudden cardiac death?

A

Sudden unexpected biologic death, presumably resulting from CVD (most commonly VF).

CSB335 (12 decks)

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