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Y1 CARDIOLOGY > Acute Coronary Syndromes > Flashcards

Acute Coronary Syndromes Flashcards

1
Q

What change/event in the atherothrombotic process can lead to ACS (MI, stroke, unstable angina)?

A

Plaque rupture consequently occluding critical areas (coronary artery)

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2
Q

Describe chronic/stable angina

A

Fixed stenosis due to atheroma limits blood flow

Pain on exertion, relieved by rest/GTN spray

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3
Q

What are the 3 (main) acute coronary syndromes?

A

Unstable angina
NSTEMI
STEMI

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4
Q

What factors favour plaque rupture?

A

Thin fibrous cap
Sudden intraluminal pressure changes
High lipid content of plaque

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5
Q

How does plaque rupture affect the endothelium in terms of platelets?

A

Blood is exposed to sites it doesn’t normally see

Platelets adhere to damaged areas through vWF and collectively form haemostatic plug

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6
Q

How does unstable angina differ from stable angina?

A

Pain caused by less and less exertion, in some cases eventually at rest
GTN becoming less effective

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7
Q

How does angina differ from acute MI?

A

Shorter (10 mins vs. 30 mins)
Pain on exertion (vs. rest)
GTN relief (vs. no relief)

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8
Q

What are typical ECG changes that occur in STEMI?

A

ST elevation
T wave inversion
Q wave formation

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9
Q

Why are Q waves “useful”?

A

Signal that there has been a previous MI

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10
Q

What characteristics must the ST elevation have in order to diagnose STEMI?

A

> 1mm STE in 2+ adjacent limb leads

>2mm STE in 2+ contiguous precordial leads

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11
Q

Which leads show STE in an inferior MI?

A

II, III, aVF

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12
Q

Which leads show STE in an anterior MI?

A

V1-V6

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13
Q

Which leads show STE in an anterolateral MI?

A

I, aVL, V1-V6

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14
Q

Which leads show STE in an anteroseptal MI?

A

V1-V4

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15
Q

Which two proteins are used for diagnosing MI?

A

Troponin T or ICK enzyme

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16
Q

When does CK production peak following an MI?

A

after 24 hours

17
Q

Why is CK not commonly used solely anymore to diagnose MI?

A

Also present in skeletal muscle and brain, so elevated levels could be due to injury in these areas

18
Q

What is the benefit of troponin T?

A

Highly specific for cardiac muscle damage

19
Q

Outline immediate treatment of MI

A 
Diamorphine IV
Anti-emetic IV
Oxygen if hypoxic
Nitrate (GTN) if BP >90
Aspirin
Clopidogrel
PCI within 90 mins, or else thrombolysis
20
Q

If PCI cannot be given within 60 mins of seeing STEMI on ECG, do thrombolysis. True/False?

A

False

If PCI cannot be given within 90 mins (incorporating 40min drive time), then do thrombolysis

21
Q

If a patient fails to improve following thrombolysis, what is done?

A

Emergency angioplasty

22
Q

What is Dressler’s syndrome?

A

Post-MI syndrome, occuring weeks after MI

Pleuritic pain, pericarditis, pericardial effusion

23
Q

Could the ECG be normal in acute MI?

A

YES

24
Q

In unstable angina, troponins may be normal. True/False?

A

True

25
Q

In a patient with a bare metal stent, how long should clopidogrel therapy last?

A

3 months

26
Q

Cardiac troponin levels are negligible in healthy people. True/False?

A

True

27
Q

How long does it take for cardiac troponin levels to increase? How long do they remain elevated?

A

4-6 hours

Remain elevated for at least 7 days

28
Q

Name some contraindications to thrombolysis

A 
Trauma, haemorrhage
Recent surgery (within 2wks)
Recent stroke (within 6mths)
Severe hypertension
Active peptic ulcers
29
Q

What are some risk factors for ACS?

A 
Age
Gender
Smoking
Drug abuse/alcohol
Obesity
DM
High BP/cholesterol
Family history
Stress
30
Q

What symptoms are typically described in STEMI?

A

Severe, crushing, central chest pain that radiates to left arm and jaw - can include sweating, nausea, vomiting

31
Q

What is a common arrhythmic complication of MI? How is it managed?

A

Ventricular fibrillation

Defibrillation

32
Q

What is the difference between a STEMI and a NSTEMI?

A

There is no acute occlusion - building up and breaking down of clot

33
Q

what ECG changes can be seen in NSTEMI?

A

ST depression

NORMAL

34
Q

How is NSTEMI managed?

A

Early coronoary angiography/revascularization

35
Q

What secondary prevention methods are used following an MI?

A

Healthy lifestyle
BP control (<140/90mmHg)
Smoking cessation
Cholesterol e.g. statin therapy

Y1 CARDIOLOGY (16 decks)

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