Acute Coronary Syndromes

Question 1

which three conditions come under the umbrella term of ACS

Answer 1

unstable angina
STEMI
NSTEMI

Question 2

which condition predisposes patients to developing ACS

Answer 2

angina

Question 3

what is the pathophysiology of unstable angina

Answer 3

plaque rupture or fibrous cap erosion causing reduced coronary blood flow - can cause partial or complete occlusion by thrombus

Question 4

what are the symptoms of unstable angina

Answer 4

central stabbing chest pain possibly with radiation
pain felt upon rest
dyspnoea

Question 5

what investigations are carried out for unstable angina

Answer 5

ECG - may be normal

cardiac enzymes to rule out MI

Question 6

what is the treatment for low risk patients with unstable angina

Answer 6

aspirin and clopidogrel

nitrates

Question 7

what is the treatment for high risk patients with unstable angina

Answer 7

MONAC

revascularisation

Question 8

what is myocardial infarction

Answer 8

death of myocytes due to partial or complete occlusion of blood vessel due to thrombus

Question 9

what are the symptoms of MI

Answer 9

new onset of severe central chest pain at rest
radiating to jaw, neck, left arm
breathlessness
associated with nausea, sweating, vomiting

Question 10

what investigations are carried out for MI

Answer 10

ECG
cardiac troponins (T and I)
exercise ECG

Question 11

what are the possible findings on ECG of an NSTEMI

Answer 11

ST depression, T wave inversion, Q waves

Question 12

how long are cardiac troponins elevated for

Answer 12

7 days

Question 13

is myocyte death from a STEMI reversible

Answer 13

no

Question 14

what are the ECG findings of a STEMI

Answer 14

ST elevation
T wave inversion
Q waves

Question 15

for a diagnosis of STEMI where must the ST elevation be present

Answer 15

> 1mm elevation in adjacent limb leads

>2mm elevation in consecutive precordial leads

Question 16

an anterior MI affects which leads

Answer 16

V2-6

Question 17

an anterolateral MI affects which leads

Answer 17

V4-6, aVL

Question 18

an anteroseptal MI affects which leads

Answer 18

V1-3

Question 19

an inferior MI affects which leads

Answer 19

II, III, aVF

Question 20

a posterior MI affects which leads

Answer 20

V1-2

Question 21

what is the immediate treatment for a STEMI

Answer 21

Morphine + anti-emetic 
Oxygen 
Nitrates 
Aspirin chewed 
Clopidogrel oral gel

Question 22

what class of drug are aspirin and clopidogrel

Answer 22

anti-platelets

Question 23

what is the first line treatment for acute STEMI

Answer 23

PCI

Question 24

what is the time frame for PCI from developing symptoms

Answer 24

90 minutes

Question 25

after 90 minutes, what is the treatment for STEMI

Answer 25

thrombolysis

Question 26

how does thrombolysis work

Answer 26

breakdown of blood clot through artificial infusion of enzyme into the blood

Question 27

what is the longterm management for patient with STEMI

Answer 27

long term antiplatelets
advise diet high in omega 3, fruit and veg
check mental health of patient as anxiety is common

Question 28

what are some complications of MI

Answer 28

future MI
other cardiac problems eg stroke
Dresslers Syndrome

Question 29

what is dresslers syndrome

Answer 29

form of pericarditis that occurs 2-10 weeks post MI

autoimmune response to the MI

Question 30

what are some contraindications of MI

Answer 30

recent surgery
stroke
severe hypertension
active peptic ulcers