Acute Coronary Syndromes

Question 1

What causes an acute MI?

Answer 1

atherosclerotic plaque ruptures - leads to a reduced coronary blood flow (due to a partial complete occlusion of a thrombus) and so myocardial ischaemia.

Question 2

What are the symptoms of an acute MI?

Answer 2

Severe crushing chest pain.
Pain radiates to Jaw/left arm. 
Sweating/nausea.
Sudden onset.
Prolonged pain not relieved by GTN spray.

Question 3

What are the three types of Acute coronary syndrome?

Answer 3

Unstable angina.
ST elevated MI (STEMI).
non-ST elevated MI (NSTEMI).

Question 4

What would the ECG for a STEMI look like?

Answer 4

Elevated ST segment.
Q waves.
T wave inversion.
New left bundle branch block.

Question 5

What does a raised Troponin level suggest?

Answer 5

Could be a stemi but could be loads of cardiac conditions.

Question 6

What specific Troponins would you look for?

Answer 6

Troponin T and P.

Question 7

What antiplatelets drugs would you use to treat a STEMI?

Answer 7

Aspirin.
Clopidogrel.
Ticagrelor.

Question 8

How does clopidogrel and ticagrelor work?

Answer 8

Stops the binding of ATP to platelet surface (P2Y12), changes the conformation.

Question 9

How long does it take for troponin level to become elevated?

Answer 9

4 hours.

Question 10

Which artery usually gets blocked in ACS?

Answer 10

Left anterior descending coronary artert.

Question 11

What anticholesterol drugs would you use for treating a stemi?

Answer 11

Statins (atorvastatin/simvastatin).

Question 12

What initial treatment would you give to someone with a STEMI?

Answer 12

Morphine (and anti-emetic if nausea).
Oxygen (If levels are <90%)>
Nitrates (GTN spray)
Aspirin (300mg oral chewable).

Clopidogrel/Ticagrelor

Question 13

What is the gold standard way to treat an acute MI within 90 minutes of the MI occuring (although you can do this procedure up to 120 minutes)?

Answer 13

PPCI - Primary coronary angioplasty +- a stent.

Question 14

What treatment is given if a cath lab is not available?

Answer 14

IV thrombolysis

Question 15

What past medical history might mean that thrombolysis shouldn’t be done?

Answer 15

If they have had something that has them at risk of bleeding.

Question 16

How long after the MI would you prescribe a) aspirin b) P2Y12 inhibitor

Answer 16

a) the rest of their life.

b) 6 months.

Question 17

Describe the three steps of the platelet cascade?

Answer 17

Initiation - vascular cell wall damage.
Activation - inflammation and activator release.
Vascular blockage.

Question 18

What are the complications of a STEMI?

Answer 18

Death
Rupture of heart septum/papillary muscle.
oEdema 
Arrhythmia/aneurysm.
Dressler's syndrome.
DREAD.