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Y3 Conditions > Acute Coronary Syndromes (ACS) > Flashcards

Acute Coronary Syndromes (ACS) Flashcards

1
Q

ACS

What diseases does this term encapsulate?

A
  • unstable angina
  • NSTEMI
  • STEMI
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2
Q

ACS

How is UA defined?

A

evidence of myocardial damage (e.g. chest pain at rest) in the absence of changes to cardiac biomarkers.

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3
Q

ACS

How is NSTEMI defined?

A

evidence of myocardial damage with elevated cardiac biomarkers but no ST elevation on ECG.

It represents a partial-thickness infarct.

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4
Q

ACS

How is STEMI defined?

A

evidence of myocardial damage with elevated cardiac biomarkers and persistent ST elevation on ECG

It represents a full-thickness infarct.

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5
Q

ACS

Name 7 modifiable risk factors.

A
  • Smoking
  • Type 2 diabetes
  • Hypertension
  • Hypercholesterolaemia
  • Obesity
  • Sedentary lifestyle
  • Cocaine use
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6
Q

ACS

Name 3 non-modifiable risk factors.

A
  • Increasing age
  • Male
  • Family history
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7
Q

ACS

Name some symptoms of ACS

A
  • Central or left-sided “crushing” chest pain which may radiate to jaw or left arm
  • Shortness of breath
  • Sweating
  • Nausea & Vomiting

Note that there may be atypical presentations (e.g. dyspepsia, absence of chest pain) in females, diabetics or the elderly.

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8
Q

ACS

What are some bedside investigations that can be done?

A
  • Basic observations
  • Serial ECGs - STEMI: ST-elevation in certain leads depending on area of infarction
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9
Q

ACS

What artery supplies the lateral heart territory?

A

Left circumflex artery

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10
Q

ACS

What artery supplies the anteroseptal heart territory?

A

Left anterior descending artery

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11
Q

ACS

What artery supplies the inferior heart territory?

A

Posterior descending artery which is from right coronary in 80%
or
left circumflex in 20%

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12
Q

ACS

What artery supplies the posterior heart territory?

A

Posterior descending artery which is from right coronary in 80%
or
left circumflex in 20%

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13
Q

ACS

What leads on an ECG will show ischaemic changes if the LCx is occluded?

A

I, aVL,V5 and V6

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14
Q

ACS

What leads on an ECG will show ischaemic changes if the LAD is occluded?

A

V1 – V4

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15
Q

ACS

What leads on an ECG will show ischaemic changes if the inferior heart territory has been damaged?

A

II, III and aVF

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16
Q

ACS

What leads on an ECG will show ischaemic changes if the posterior heart territory has been damaged?

A

Reciprocal changes
i.e. prominent R waves, flat ST depression and T wave inversion in V1-V4

17
Q

ACS

What might you see in an ECG of someone with NSTEMI or UA?

A

T-wave inversion
or
ST-depression

18
Q

ACS

What bloods might you do when investigating for ACS and why?

A
  • Cardiac markers
    Serial troponin is commonly taken clinically
    Raised in NSTEMI and STEMI 4-6hours after injury and remains elevated for 10 days
  • CK-MB and myoglobin can also be measured
  • FBC (anaemia)
  • U&E (hyperkalaemia may cause arrythmias)
  • Blood glucose and lipid profile (to assess for risk factors)
19
Q

ACS

What is the diagnostic investigation of choice?

A

Coronary angiogram is the diagnostic investigation of choice

20
Q

ACS

Why differential are you trying to exclude by doing a CXR?

A

to exclude pneumothorax

21
Q

ACS

Why might you do an ECHO?

A

to assess function of heart

22
Q

ACS

How to manage STEMI:

  1. if it has been <12hr from symptom onset and PCI is available within 2hrs
  2. if it has been >12hr from symptom onset but PCI is NOT available within 2hrs
  3. if it has been >12hr from symptom onset
A
  1. give anticoagulants + send the patient for PCI
  2. give anticoagulants + start thrombolysis with drugs such as alteplase.
  3. Offer ticagrelor with aspirin unless high bleeding risk
    Consider clopidogrel with aspirin, or aspirin alone, for high bleeding risk
23
Q

ACS

How to treat STEMI if <12hr since symptom onset?

A
24
Q

ACS

How to treat STEMI if >12hr since symptom onset?

A
25
Q

ACS

What scoring system is used to risk stratify NSTEMI or UA pts?

A

GRACE score

26
Q

ACS

If a pt with NSTEMI has ongoing ischaemia, what 2 procedures may they undergo and under which conditions?

A
  1. PCI (if available)
  2. CABG
27
Q

ACS

What are the indications for CABG?

A
  • multiple vessel involvement
  • left main coronary artery involvement
28
Q

ACS

If GRACE score is low for pts with NSTEMI/UA what is the management?

A

conservative management without angiography
- Offer ticagrelor with aspirin unless high bleeding risk
- Consider clopidogrel with aspirin, or aspirin alone, for high bleeding risk

29
Q

ACS

If GRACE score is high for pts with NSTEMI/UA what is the management?

A

immediate angiography if clinically unstable
Otherwise, consider angiography (with follow-on PCI if indicated) within 72 hours if no contraindications.

  • If no separate indication for oral anticoagulation, offer ticagrelor with aspirin.
  • If a person has a separate indication for oral anticoagulation, offer clopidogrel with aspirin
30
Q

ACS

Longer term, how is ACS managed (prescribing)?

A
  • Beta blocker – often bisoprolol as it is cardioselective
  • ACE-inhibitor
  • Dual antiplatelet for 1 year and then aspirin indefinitely (switch to 75mg)
  • High dose (80mg) statin
31
Q

ACS

Longer term, how is ACS managed (risk factor wise)?

A
  • Good diabetic control
  • Smoking cessation
  • Good blood pressure control
  • Statins for hypercholesterolaemia
  • Diet and exercise
32
Q

ACS

What are some features of acute heart failure?

A
  • jugular venous distention
  • crackles on lung auscultation
  • new s3 gallop
  • murmur
  • orthopnoea
  • oedema
33
Q

ACS

What is MONA?

A

M - morphine
O - oxygen (sat >90%)
N - nitrates (subling or IV)
A - aspirin (325mg)

34
Q

ACS

How do we manage ACS initially and acutely?

A
  1. iv access + obs/stats
  2. MONA
  3. high intensity statin
  4. beta-blocker

Y3 Conditions (55 decks)

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