Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Cardiovascular system > Acute coronary syndromes and management > Flashcards

Acute coronary syndromes and management Flashcards

1
Q

what is an acute coronary syndrome?

A

Any sudden cardiac event suspected or proven to be related to a problem with the coronary arteries (problems arise from myocardial ischaemia)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

what is a major (full blown) MI?

A

complete coronary artery occlusion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

what is a minor (warning) MI?

A

partial (or transient complete) coronary artery occlusion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

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

A

ST elevation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

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

A

Q waves

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

what does an ECG of partial coronary occlusion look like?

A

no ST elevation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

what does an ECG of a partial coronary occlusion look like after 3 days?

A

no Q waves

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

is unstable angina an acute coronary syndrome?

A

yes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

is stable angina an acute coronary syndrome?

A

no

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

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

A

full thickness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

in an NSTEMI what thickness of the heart muscle is affected?

A

only partial thickness damage, usually sub-endocardial

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

how are MIs diagnosed?

A
  1. detection of cardiac cell death by detecting positive cardiac biomarkers
  2. plus of the following:
    - symptoms of ischeamia
    - new ECG changes
    - evidence of coronary problem on coronary angiogram or autopsy
    - evidence of new cardiac damage on another test
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

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

A

troponin BI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

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

A

troponin B2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

what are some non-cardiac causes of troponin rise?

A

Pulmonary embolism
Sepsis
Renal failure
Sub-arachnoid haemorrhage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

what is unstable angina?

A

unpredictable, rapidly worsening/ crescendo angina or angina at rest

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

is a 20 year old with elevated troponin levels but with pneumonia, in ICU and with normal ECG likely to have had an MI?

A

no, it is mostly due to a supply-demand mismatch of the heart causing strain and releasing troponin.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

what is a type 1 MI?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

what is a type 2 MI?

A

due to imbalance in supply and demand of oxygen. Result of ischaemia but not ischaemia from thrombosis of coronary artery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

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

A
  • Coronary vasospasm
  • coronary dissection
  • embolism of material down coronary artery
  • vasculitus (of coronary artery)
  • radiotherapy causing fibrosis and stenosis of coronary arteries
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

what can cause coronary vsospasm, possibly leading to type 1 MI?

A

cocaine, triptans (anti-migrain medication), chemotherapy (5-FU)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What can cause embolism of material down the coronary artery possibly causing a type 1 MI?

A

thrombosis from mechanical valve, tumour, AF

23
Q

what may the ST segment of the ECG look like in a NSTEMI?

A

ST depression

T wave inversion

24
Q

which ECG readings give an indication of what is going on in the high lateral portion of the heart?

A

SLL I, aVL

25
Q

which ECG readings give an indication of what is going on in the inferior of the heart?

A

SLL II, SLL III, aVF

26
Q

which ECG readings give an indication of what is going on in the anterior of the heart?

A

V1, V2, V3, V4

27
Q

which ECG readings give an indication of what is going on in the lateral side of the heart?

A

V5, V6

28
Q

what portion of the heart is not covered by the normal ECG leads?

A

posterior

29
Q

when might an MI not show up on an ECG?

A

if the occlusion occurs in the RCA or the left circumflex artery

30
Q

if there is an occlusion of the RCA and a posterior MI occurs, what changes may be visible?

A

lateral changes

31
Q

what is sort of chest pain is associated with MI?

A
  • radiating to neck and arm
  • may not be “pain”, more discomfort
  • severe but not agony
  • associated nausea, sweating and breathlessness
32
Q

what are the risk factors for MI?

A 
Male
Age
Known heart disease
High blood pressure
High cholesterol
Diabetes
Smoker
Family history of premature heart disease
33
Q

what is the order of investigations to diagnose MI?

A
  1. symptoms- ACS or not
  2. ECG to look for ST elevation or not
  3. 3-4 hours -laboratory test for troponin if not ST-elevation (yes NSTEMI, no unstabel angina)
  4. 1-2 days - ECG to look for Q waves (yes Qw MI, no NQMI)
34
Q

with a STEMI what is the aim of treatment?

A

open coronary artery

35
Q

what are the immediate treatments for STEMI?

A
  1. get patient to cath lab for primary percutaneous coronary intervention
  2. if cath lab not available, thrombolysis
36
Q

what is the medication given to patients with STEMI and where a cath lab is not available?

A

tenecteplase given as a bolus

37
Q

what are the risks of thrombolysis?

A

severe bleeding

38
Q

when should thrombolysis not be carried out in someone with a STEMI?

A

recent previous stroke, previous intracranial bleed

or recent surgery, on warfarin or severe hypertensive

39
Q

what is the general management of suspevted ACS?

A

Admit to hospital
Cardiac monitor
Give O2 only if levels low

40
Q

what are the investigations that must be carried out for ACS?

A

-serial ECGs
-Blood tests
check not anaemic
check kidney function
cholesterol
thyroid

41
Q

which medications are given if patients with ACS get more chest pain?

A

GTN

opiates (eg. morphine)

42
Q

what are the general types of medication given to patients with ACS?

A 
anti-platelet drugs
anti-thrombotic drugs
Beta blockers
statin
ACE inhibitor
43
Q

what anti-platelet drugs are given to patients with ACS and what doses?

A

aspirin-300mg loading dose then 75mg once a day

ticagrelor-180mg loading dose then 90 mg two times a day

44
Q

what anti-thrombotic drug is given to patients with ACS and what doses?

A

fondaparinux- 2.5 mg once a day subcutaneously

45
Q

what bets blocker is given to patients with ACS and what doses?

A

Bisoprolol 2.5 mg od

46
Q

what statin is given to patients with ACS and what doses?

A

Simvastatin 40 mg od

47
Q

what ACE inhibitor is given to patients with ACS and what doses?

A

Ramipril 1.25 mg bd

48
Q

which patients with NSTEMI require a coronary angiogram?

A

patients at high risk

49
Q

what are the risks of coronary angiography/angioplasty/stenting?

A 
Bleeding
Blood vessel damage
Myocardial infarction
Coronary perforation
Stroke
Dye can affect kidneys (“contrast nephropathy)
50
Q

when is a coronary bypass graft performed?

A
  • three vessel disease
  • left main stem disease
  • disease not amenable to PCI
51
Q

what are the potential complications of MI

A
  • Arrhythmia
  • Cardiogenic shock
  • Myocardial rupture
  • valve dysfunction due to papillary muscle dysfunction/rupture
  • acute ventricular septal defect
52
Q

what must be carried out predischarge of an ACS patient?

A

Check on correct medications
Address risk factors
Cardiac rehabilitation
Follow-up plans

53
Q

what medication is given after a coronary stent is put in?

A

dual anti-platelet therapy for anything from 1 month to 12 months
(to prevent thrombosis on stent before endothelium covers it)

54
Q

what are the possible long term complications of a coronary stent?

A
  • Higher risk of bleeding as on anti-platelet drugs
  • Increased risk of further myocardial infarction/death
  • Cardiac failure

Cardiovascular system (40 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions