Acute coronary syndromes

Question 1

What are the different acute coronary syndromes?

Answer 1

Unstable angina

STEMI

NSTEMI

Question 2

What is present on an initial ECG and an ECG at 3 days for complete coronary occlusion?

Answer 2

ST elevation then Q waves

• Hyperacute T waves

Question 3

What is present on an initial ECG and an ECG at 3 days for partial coronary occlusion?

Answer 3

No ST elevation then No Q waves

• ST depression
• T wave inversion
• May be normal

Question 4

What is the main example of chronic ischaemic heart disease?

Answer 4

Stable angina

Question 5

How do you diagnose MI?

Answer 5

Detection of cardiac cell death
- Positive cardiac biomarkers (TROPONIN)

• Symptoms of ischaemia
• New ECG changes
• Evidence of coronary problem on coronary angiogram or autopsy
• Evidence of new cardiac damage on another test

Question 6

What are non-cardiac causes of troponin rise?

Answer 6

• Pulmonary embolism
• Sepsis
• Renal failure
• Sub-arachnoid haemorrhage

Question 7

What are the different types of MIs?

Answer 7

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

Question 8

Which arteries correspond with inferior, anterior and lateral MI?

Answer 8

Right coronary artery = Inferior MI

Left anterior descending coronary artery = Anterior MI

Circumflex coronary artery = Lateral MI

Question 9

What are common causes of cardiac chest pain?

Answer 9

Coronary artery disease
Aortic valvular disease
Pulmonary hypertension
Mitral valve prolapse 
Pericarditis 
Idiopathic hypertrophic subaortic stenosis

Question 10

What are cardiac risk factors?

Answer 10

Male 
Age
Known heart disease
Hypertension 
High cholesterol 
Diabetes 
Smoker 
Family history of premature heart disease

Question 11

What are treatments for ACS?

Answer 11

Reperfusion therapy: Mechanical, primary PCI or pharmacological

• Angioplasty
• Thrombolysis (tenecteplase)

Question 12

What are investigations to carry out?

Answer 12

• Serial ECGs: consider posterior leads

- Blood tests: check not anaemic, check kidney function, cholesterol, thyroid

Question 13

If patient has more chest pain what can you give them?

Answer 13

Glycerol trinitrate (GTN)

• Vasodilator, opens up coronary arteries
• Can give sub-lingual or as intravenous infusion

Opiates (e.g. morphine)

• Helps relieve anxiety too
• Also helps venodilate

Question 14

Antiplatelet drugs used

Answer 14

Aspirin

Clopidogrel

Ticagrelor

Question 15

Anti-thrombotic drugs used

Answer 15

Heparin

LMWH

Fondaparinux

Question 16

Other pharmacology used

Answer 16

Beta blockers

Statins

ACE inhibitors

Question 17

What are risks of coronary angiography/angioplasty/stenting?

Answer 17

Bleeding 
Blood vessel damage 
Myocardial infarction
Coronary perforation
Stroke 
Dye can affect kidneys

Question 18

What are complications following an MI?

Answer 18

Arrhythmia 
Mechanical:
cardiogenic shock
myocardial rupture
Valve dysfunction due to papillary muscle dysfunction/rupture
Acute ventricular defect

Question 19

What should you do pre-discharge for ACS?

Answer 19

Check on correct medications
Address risk factors
Cardiac rehabilitation
Follow-up plans