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Cardiovascular System > Acute Coronary Syndromes (ACS) > Flashcards

Acute Coronary Syndromes (ACS) Flashcards

1
Q

What is an ACS?

A

Any sudden cardiac event related to a problem with the coronary arteries (problems arise du to myocardial ischaemia)

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2
Q

How can an atheroma lead to a MI?

A
  • Fibrous cap of plaque injured and thrombus formed
  • In more advanced, cap completely ruptures - contents released and thrombus forms

Platelets release serotonin and thromboxane A2 - causes vasoconstriction in the area (ischaemia)

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3
Q

What are the symptoms of ACS?

A

Chest pain
Nausea
Sweating
Breathless

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4
Q

Describe ischaemic chest pain

A

Dull retrosternal pain
More of a pressure
May radiate to jaw, neck, arm

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5
Q

What are the signs on clinical examination?

A 
3rd HS (early diastole) 
Pansystolic murmur (S1 to S2) 
Pericardial rub 
Crepitations in lung - Pul. oedema 
Hypotension 
Quiet S1
Narrow pulse pressure 
Raised JVP
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6
Q

How is the diagnosis made?

A
  1. History - signs/symptoms
  2. ECG changes
  3. Positive cardiac enzyme tests - troponin and creation kinase
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7
Q

What investigations should be carried out?

A

ECG

FBC 
U+E 
LFT
TFT
Blood glucose (diabetes)
Lipid profile 
Cardiac enzymes 
ABG

CXR

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8
Q

What is the general management of suspected ACS?

A 
Morphine 
O2
Nitrates (GTN)
Aspirin 
Clopidogrel
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9
Q

What is given got for STEMI treatment?

A

Thrombolysis (TNK)
PCI
B blockers
ACEi

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10
Q

What is given for NSTEMI treatment?

A 
CABG 
Antiplatelet (aspirin, Clopidogrel)
Anti-thrombotic (heparin, fonaparinux)
BB (bisorolol) - peripheral vasodilation - reduces CO, HR and contractility 
Statin (simvastin)
ACEi (ramipril)
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11
Q

What are the risk factors of ACS?

A 
Male
Age 
Known heart disease 
High BP 
High cholesterol 
Diabetes 
Smoker
FH of premature heart disease
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12
Q

What is the action of antiplatelet agents?

A

Aspirin inhibits thromboxane A2 production which stimulates platelet aggregation and vasoconstriction, abnormal blood flow (causing atheroma) and vasospasm

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13
Q

What is the action of glycoprotein II/b/IIa receptor inhibitors?

A

GPIIb/IIa is a complex on platelet, and the receptor for fibrinogen aids in platelet activation

Clopidogrel blocks by inhibiting fibrinogen from binding to GPIIb/IIa receptor.

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14
Q

What is the action of BB?

A

Competitively inhibit myocardial effects of circulating catecholamines and reduce myocardial O2 consumption by lowering HR, BP and contractility

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15
Q

What is the goal of pharmacotherapy?

A

Increase myocardial O2 supply through coronary vasodilation

Decrease myocardial O2 demand by decreasing HR, BP, preload or myocardial contractility

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16
Q

What is a major (full blown) MI?

A

Complete coronary artery occlusion

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17
Q

What is a minor (warning) MI?

A

Partial (or transient complete) coronary artery occlusion

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18
Q

What does the initial ECG of a complete coronary occlusion show?

A

ST elevation

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19
Q

What does the ECG of a complete coronary occlusion show after 3 days?

A

Q waves

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20
Q

What does the initial ECG of a partial coronary occlusion show?

A

No ST elevation

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21
Q

What does the ECG of a partial coronary occlusion show after 3 days?

A

No Q waves

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22
Q

Is stable angina an acute coronary syndrome?

A

No, it is a chronic ischaemic heart disease

23
Q

Is unstable angina an acute coronary syndrome?

A

Yes

24
Q

In a STEMI what thickness of the heart muscle is affected?

A

Full thickness (transmural MI)

25
Q

In a NSTEMI what thickness of the heart muscle is affected?

A

Partial thickness (subendocardial MI)

26
Q

How is MI diagnosed?

A

+Ve cardiac biomarkers (myocyte death)

AND one of:
Ischaemic symptoms 
ECG changes 
Angiogram shows coronary problem
Cardiac damage on another test
27
Q

What protein is used as a biomarker to detect if a major MI has occurred?

A

Troponin B1

28
Q

What protein is used as a biomarker to detect if a minor MI has occurred?

A

Troponin B2

29
Q

What are some non-cardiac causes of troponin rise?

A

Pulmonary embolism
Sepsis
Renal failure
Sub-arachnoid haemorrhage

30
Q

What is a Type I MI?

A

A spontaneous MI associated with ischaemia and due to primary coronary events such as plaque erosion, rupture, fissuring or dissection

31
Q

What are some other causes of type 1 MI that are not atherosclerosis?

A

Coronary vasospasm
Coronary dissecion
Embolism of coronary artery
Inflammation of coronary artery (vasculitis)
Radiotherapy to chest can cause fibrosis and stenosis of coronary arteries

32
Q

What might the ST segment of the ECG look like in a NSTEMI?

A

Could be ST depression

33
Q

Why can posterior MI be easily missed?

A

A there are no chest lead on the back of the chest

34
Q

What MI can a problem with the right coronary artery cause?

A

Inferior MI

35
Q

What MI can a problem with the LAD coronary artery cause?

A

Anterior MI

36
Q

What MI can a problem with the L circumflex coronary artery cause?

A

Lateral MI

37
Q

For posterior MI, what precordial chest lead should you look at on an ECG?

A

V1-V2 as you see opposite changes as they’re opposite the posterior side

38
Q

How many cases per year of MI are there?

A

300 000

39
Q

What can a CXR show in an ACS?

A

Cardiomegaly
Pul. oedema
Widened mediastinum

40
Q

What are two treatments that restore reperfusion of occluded artery?

A

Primary percataneous coronary intervention (PCI)

Pharmacological

41
Q

What are you looking for in FBC investigation?

A 
Anaemia 
Inflammation markers (WBC)
42
Q

What are two cardiac enzymes?

A

Troponin

Creatine kinase

43
Q

What is the thrombolysis agent used?

A

Tenecteplase (TNK)

44
Q

What do you need to be about with thrombolysis?

A

Bleeding
Dont give to those if recent stroke or previous intracranial bleed
Caution if recent surgery, on warfarin, severe HPT

45
Q

Cath lab vs thrombolysis

A

Cath lab for PCI first choice if you can get to it with 2hrs
Thrombolysis works if given early but likely to cause bleeding

46
Q

What type of individuals are more likely to get an NSTEMI than STEMI?

A

Older
Prev MI
Prev CABG/PCI

47
Q

What is the management given more more chest pain after admission?

A

GTN - vasodilation of coronary arteries

Opiates (morphine) - relieve anxiety and venodilates

48
Q

List 2 anti platelet drugs

A 
Aspirin 
Clopidogrel (or ticagrelor 180mg then 90mg bd)

Both 300mg then 75mg od

49
Q

List 3 anti-thrombotic drugs

A

Heparin
LMWH
Fondaparinux (2.5mg od)

50
Q

What are the risks of coronary stunting?

A 
Bleeding 
Blood vessel damage 
MI
Coronary perforation 
Stroke 
Dye can affect kidneys
51
Q

What are the complications following an MI?

A

Arrhythmias

Mechanical: cariogenic shock, myocardial rupture

52
Q

What are other mechanical problems hat can arise from MI but not cause death?

A

Valve dysfunction due to papillary muscle dysfunction/rupture
Acute ventricular septal defect

53
Q

Why are anti platelets required after a stent?

A

Takes time for stent to become endothelialised into coronary artery wall, so until then it is exposed to blood and can cause thromboses, blocking off the stent unless of antiplatelets

1 to 12 months of dual anti-platelet therapy (DAPT)

Cardiovascular System (37 decks)

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