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Year 2 > Acute Coronary Syndromes > Flashcards

Acute Coronary Syndromes Flashcards

1
Q

Define Acute Coronary Syndrome

A

Covers a spectrum of acute cardiac conditions from unstable angins to varying degrees of MI

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2
Q

What indicates a Q-wave infarction

A

ST elevation

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3
Q

What indicates a Non-Q infarction

A

ST depression/ T wave inversion

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4
Q

What indicates an unstable angina on an ECG

A

Normal (can’t detect)

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5
Q

Clinical classification of unstable angina

A
  1. Cardiac chest pains at rest and increasing

2. No rise in troponin levels

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6
Q

When can MI be diagnosed on ECG alone

A

If ST is elevated

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7
Q

When is diagnosis made if there is no ST elevation but MI has happened

A

After troponin results come in

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8
Q

What are characteristics of a non Q-wave MI

A
  1. Poor R wave progression
  2. Biphasic (inverted) T wave
  3. ST elevation
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9
Q

Signs of an MI

A
  1. Unremitting
  2. Severe
  3. Occurs at night
  4. Sweating
  5. Breathlessness
  6. Nausea
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10
Q

Risks that increase MI chances

A
  1. Higher age
  2. Diabetes
  3. Renal Failure
  4. Left ventricular systolic dysfunction
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11
Q

How is MI initially managed

A
  1. 999!
  2. if ST elevation is seen by paramedic, transfer to PCI centre
  3. 300mg aspirin immediately
  4. Pain relief
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12
Q

How is MI managed in hospitals

A
  1. Diagnosis
  2. Bed rest
  3. Oxygen therapy
  4. Narcotics/nitrates
  5. Aspirin and P2Y12 inhibitor
  6. Beta-blockers
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13
Q

How is ACS commonly caused

A

Plaque rupture - arterial thrombosis

or CORONARY VASOSPASM (not common)

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14
Q

What is troponin

A

Regulates actin:myosin contraction

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15
Q

Why is looking at troponin levels not accurate for MI

A
  1. Positive in pulmonary embolism
  2. Myocarditis
  3. Arrythmias
  4. Heart failures
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16
Q

How does aspirin function

A
  1. Inhibits COX-1 and COX-2 which produce PROSTAGLANDINS

irreversibly

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17
Q

Role of prostaglandins

A

Pro-inflammatory - induce clotting

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18
Q

Role of P2Y12

A

Promotes platelet proliferation

19
Q

Name three P2y12 inhibitors

A

Clopidogrel
Prasugrel
Ticagrelor

20
Q

Problem with P2Y12 inhibtors

A

Can cause severe bleeding

21
Q

What are GP11b/IIIa antagonists

A

Intravenous drugs

22
Q

What are sued in conjunction with GPIIb/IIIa antagonists

A

Aspirin and oral P2Y12 inhibitors

23
Q

Why has the use of GPIIb/IIIa decreased

A

Oral anti platelet therapy more convenient

24
Q

When is GPIIb/IIIa still given

A

In patients taken opiates which are delaying gastric emptying

25
Q

What are anticoagulants used for

A

Target formation of thrombin

Inhibit fibrin formation and platelet activation

26
Q

Why is Fondaparinux better than heparin

A

Fonaparinux is safer because of low-level of anticoagulation used

27
Q

What anticoagulant is usually used during PCI

28
Q

When else is heparin used

A

CABG surgery

29
Q

What are given to patients with heart failure

A

Diuretic
ACEI
Beta Blocker
Aldosterone antagonist

30
Q

When is coronary angiography performed

A

Patients with troponin elevation or unstable angina

31
Q

What is the most common revascularisation procedure

32
Q

Name drugs that inhibit thrombin

A

Heparin
Apixaban
Bivalirudin
Rivaroxaban

33
Q

How is clopidogrel activated/ inactivated

A

In the liver

34
Q

What factors effect response to clopidogrel

A
  1. Dose
  2. Age
  3. Weight
  4. Disease states (diabetes)
  5. Drug-drug interactions
  6. CYP loss of function
35
Q

Describe the activation of Clopidogrel

A

Clopidogrel -> 2-oxo-clopidogrel -> R-130964

36
Q

Describe the activation of prasugrel

A

Prasugrel -> R-95913 -> R-138727

37
Q

Describe the mechanism of action of ticagrelor

A

Inhibits adenosine uptake by cells via the ENT-1 channels in the membrane

38
Q

Role of adenosine in the blood

A

Cause vasodilation
Caridoprotection
Anti platelet

39
Q

Adverse effects of ticagrelor

A

Bleeding
Rash
Gi disturbances

40
Q

How is dyspnoea caused by using ticagrelor resolved

A

Switching to prasugrel and clopidogrel

41
Q

What is the idiosyncratic effect of ticagrelor

A

Ventricular pauses

42
Q

How is an acute STEMI treated

A
  1. ECG
  2. Tropinin/ Glucose count in FBC
  3. 300mg ASPIRIN
  4. 180mg Ticagrelor
  5. Morphine (5-10mg) + metoclopramide (anti-emetic)
  6. PCI or Fibrinolysis
43
Q

Non-STEMI treatment

A
  1. Low flow O2
  2. Morphone + Metoclopramide
  3. GTN spray
  4. 300mg Aspirin
  5. 2.5mg Fondaparinux
  6. Ticagrelor
  7. IV GTN
  8. ORAL BISOPROLOL

Year 2 (155 decks)

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