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Cardiovascular Medicine > Acute coronary syndromes > Flashcards

Acute coronary syndromes Flashcards

1
Q

What is ST- elevation MI?

A

Patients presenting with cardiac-sounding chest pain with persistent ST segment elevation (or new LBBB) on their ECG.

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2
Q

What is hs-tnl?

A

High sensitivity troponin I released from cardiac myocytes due to necrosis

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3
Q

In a STEMI, how many mm should the ST elevation be in limb leads?

A

greater than 1mm

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4
Q

In a STEMI, how many mm should the ST elevation be in chest leads?

A

greater then 2mm

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5
Q

In a STEMI what should the hs/Tnl be?

A

greater than 100ng/L

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6
Q

In a STEMI what should the CK level be?

A

greater than 400

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7
Q

What is a Non-ST elevation MI?

A

Patients presenting with cardiac-sounding chest pain. The ECG may show ST segment depression, T wave inversion or be normal

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8
Q

In a NSTEMI what should the hs/Tnl be?

A

greater than 100

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9
Q

What is unstable angina?

A

Patients presenting with cardiac-sounding chest pain, ECG can show ST segment depression, T wav inversion or be normal and the hs/TNl will be in normal range

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10
Q

When do Tnl levels begin to rise?

A

3-4 hours after myocardial damage and stay elevated for up to two weeks

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11
Q

What Tnl level in men suggests a high likelihood of myocardial necrosis?

A

greater than 34ng/L

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12
Q

What Tnl level in women suggest a high likelihood of myocardial necrosis?

A

greater than 16ng/L

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13
Q

When should hs/Tnl be taken?

A

On admission and again at 1 hour, if uncertainty a further sample can be taken further 2 hours later. only one level is required if the onset of symptoms was 3 or more hours previously

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14
Q

When can there be false positive elevation of hs/Tnl?

A

Renal failure, pulmonary embolism, severe congestive heart failure, myocarditis, aortic dissection, aortic stenosis, hypertrophic cardiomyopathy, malignancy, stroke, sepsis

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15
Q

What leads of an ECG would show an inferior STEMI?

A

II, III, AVF

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16
Q

What leads of an ECG would show a anterior STEMI? Which of these are septal?

A

V1 to V4

V1 and V2 are septal

17
Q

What leads of an ECG would show a lateral STEMI?

A

1, V5, V6

18
Q

What conditions can mimic STEMI on the ECG?

A

Early depolarisation causing up-sloping ST elevation, mainly in leads V1 and 2, common in younger athletic Afro-Caribbean patients.
Concave ST elevation in pericarditis. Brugada syndrome may also be misdiagnosed as anterior STEMI. Takotsubo cardiomyopathy (stress reaction mostly by middle aged females)

19
Q

What is the management for a STEMI?

A

IV access
Morphine and an anti-emetic
Oxygenation (if hypoxic and sats >94%)
Aspirin (300mg loading followed by 75mg for life)
Clopidogrel (600mg loading dose followed by 75mg)
PPCI- restoration of flow
Full biochemical screen- lipid profile, random glucose and HbA1c, full blood count

20
Q

After a STEMI, what medications should be given long term?

A

Aspirin and Clopidogrel

Bisoprolol, ACE inhibitor, ARBs, Statin

21
Q

Why is Aspirin given for a STEMI?

A

Anti-platelets by blocking thromboxane A2

22
Q

Why is clopidogrel given for a STEMI?

A

Anti-platelets by inhibiting ADP receptors

23
Q

Why is bisoprolol given for a STEMI?

A

Beta blocker to reduce heart rate, avoid shock or hypotension

24
Q

Why are ACE inhibitors given for a STEMI?

A

Prevent muscle over damage e.g. ramipril

25
Q

Why are ARBs given for a STEMI?

A

Prevent muscle over damage e.g. losartan

26
Q

Why is a Statin given for a STEMI?

A

To reduce cholesterol levels by inhibiting HMG-CoA reductase e.g. atorvastatin

27
Q

What other conditions need to be controlled after an STEMI?

A

Diabetes and hypertension

28
Q

What lifestyle modification is very important after a STEMI?

A

Smoking cessation

29
Q

What is triple therapy for AF?

A

Some patients may be taking anticoagulant e.g. warfarin as well as aspirin and clopidogrel

30
Q

What is the management for an NSTEMI?

A

Morphine and an anti-emetic, aspirin 300mg loading dose and 75mg od, low molecular weight heparin e.g. Enoxaparin, Repeat ECG, risk assessment if elevated hs-Tnl, Ticagrelor (anti-thrombotic) angiography, anti-anginals

31
Q

What should be given with triple therapy for AF?

A

A proton pump inhibitor to reduce the chance of gastric ulcers due to the increased risk of bleeding

Cardiovascular Medicine (6 decks)

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