Acute coronary syndromes

Question 1

What is an acute coronary syndrome

Answer 1

A sudden collection of symptoms suspected or proven to be related to a problem with the coronary arteries

Question 2

Name the acute coronary syndromes

Answer 2

Unstable Angina
ST elevated MI
Non-ST elevated MI

Question 3

Is stable angina an acute coronary syndrome

Answer 3

No

Question 4

What is a Myocardial infarction

Answer 4

Cardiac cell death due to prolonged ischaemia

Question 5

What is a cardiac arrest

Answer 5

Abnormal hearth rhythm thats not compatible with life

Question 6

Give some examples of cardiac arrest

Answer 6

Atril fibrillation
Ventricular fibrillation
Tachycardia
Asystole

Question 7

What is unstable angina

Answer 7

When patients suffer discomfort at rest OR if the symptoms are worsening.

When an atheromatous plaque gets disrupted and platelets start aggregating.

Question 8

What is a NSTEMI

Answer 8

Partial coronary occlusion
No ST elevation (can be depression)
Inverted T waves
Pathological Q waves

Question 9

What happens to Q waves in an NSTEMI

Answer 9

No Q waves after 3 days

Question 10

What is a STEMI

Answer 10

Complete coronary occlusion

ST elevation

Question 11

What happens to Q waves in an STEMI

Answer 11

Q waves after 3 days

Question 12

What are the presenting symptoms of acute coronary syndromes

Answer 12

Chest pain

Nausea, sweating, breathlessness

Question 13

What kind of chest pain do patients get with acute coronary syndromes.

Answer 13

Severe but not agony

Can radiate down left arm

Question 14

What can happen with diabetics getting an acute coronary syndrome

Answer 14

it can be silent

Question 15

What are risk factors for acute coronary syndrome

Answer 15

Male 
Age
High BP 
High cholesterol 
Diabetes
Smoking
Family Hx
Known heart disease

Question 16

What is difficult about examining myocardial infarction patients

Answer 16

They may look very well or completely fine

Question 17

What should be looked for in a clinical exam in suspected MI

Answer 17

Heart rate 
Blood pressure (in both arms) 
Murmurs
Crackles in chest 
Raised JVP

Question 18

What investigations should be done in suspected MI

Answer 18

ECG 
Troponin
Hb
kidney function 
cholesterol

Question 19

What is a feature on an ECG in a STEMI

Answer 19

ST elevation

Question 20

What is a STEMI

Answer 20

complete occlusion

Question 21

What is a feature on an ECG in a N-STEMI

Answer 21

ST depression

T wave inversion

Question 22

Why is an ECG a useful tool when investigating MI

Answer 22

Can differentiate between a STEMI and NSTEMI

Helps locate where the problem is ie inferior, anterior, posterior

Question 23

How do investigate a posterior ECG

Answer 23

Put leads on back of chest

Question 24

What is troponin

Answer 24

a cardiac biomarker

Question 25

What sub groups of troponin can rise in a MI

Answer 25

Troponin I | Troponin T

Question 26

What is diagnosed if ST is not elevated and no troponin is detected.

Answer 26

Unstable angina

Question 27

What can cause an increase in troponin

Answer 27

``` Arrythmia Pulmonary embolism Trauma Sepsis Renal failure ```

Question 28

What is primary aim of STEMI treatment

Answer 28

Need to get coronary artery open ASAP

Question 29

What general methods can be used to open coronary artery in STEMI treatment

Answer 29

Mechanically | Pharmacologically

Question 30

What mechanical method is used in STEMI treatment

Answer 30

Angioplasty

Question 31

What is angioplasty

Answer 31

Using a ballon stent to mechanically open a vessel

Question 32

What pharmacological methods should be used in treatment of a STEMI (x9)

Answer 32

``` Thrombolysis (Tenecteplase) Morphine GTN Antiplatelet drugs Anti Coagulant Statin Beta Blocker ACE inhibitors Oxygen ```

Question 33

What are contraindications to thrombolysis in STEMI

Answer 33

``` Dont give if recent stroke (3 months) Ever had an intracranial bleed. Intra cranial neoplasm Suspected aortic dissection Severe hypertension Head trauma Caution if on warfarin ```

Question 34

Why is morphine used in STEMI treatment

Answer 34

Anxiety and venodilation

Question 35

Why is GTN used in STEMI treatment

Answer 35

Vasodilation

Question 36

What is dual anti-platelet therapy

Answer 36

Aspirin and Clopidogrel

Question 37

What is initial loading dose for aspirin and clopidogrel

Answer 37

300mg

Question 38

Name 2 anticoagulant drugs

Answer 38

Heparin | Fondaparinux

Question 39

What does statin do

Answer 39

Lowers cholesterol

Question 40

What do Beta blockers do

Answer 40

Block sympathetic activation of heart | ie. REDUCES WORK ON HEART

Question 41

What do ACE inhibitors do?

Answer 41

Blocks vasoconstriction and aldosterone secretion | HELPS HEART RECOVER

Question 42

Why is NSTEMI treatment more complicated

Answer 42

There may not be such an obvious coronary presentation

Question 43

What drugs can be used in NSTEMI treatment

Answer 43

``` Aspirin Clopidogrel Fondaparinux/Heparin Statins B blockers Nitrates ```

Question 44

How does aspirin work

Answer 44

Its a potent inhibitor of platelet thromboxane A2 production

Question 45

What does thromboxane A2 do

Answer 45

stimulate platelet aggregation and vasoconstriction

Question 46

What can be done to increase myocardial oxygen supply

Answer 46

Thrombolysis | Coronary vasodilation

Question 47

What can be done to decrease myocardial oxygen demand

Answer 47

Decrease heart rate decrease blood pressure decrease pre load or myocardial contractility

Question 48

In what time scale does thrombolyis need to be administered

Answer 48

Within 2 hours

Question 49

How does thrombolysis work

Answer 49

The drug converts plasminogen to the natural fibronyltic agent plasmin. Plasmin then breaks down fibrinogen and fibrin