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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)

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2
Q

what is a major (full blown) MI?

A

complete coronary artery occlusion

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3
Q

what is a minor (warning) MI?

A

partial (or transient complete) coronary artery occlusion

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4
Q

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

A

ST elevation

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5
Q

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

A

Q waves

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6
Q

what does an ECG of partial coronary occlusion look like?

A

no ST elevation

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7
Q

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

A

no Q waves

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8
Q

is unstable angina an acute coronary syndrome?

A

yes

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9
Q

is stable angina an acute coronary syndrome?

A

no

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10
Q

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

A

full thickness

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11
Q

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

A

only partial thickness damage, usually sub-endocardial

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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
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13
Q

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

A

troponin BI

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14
Q

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

A

troponin B2

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15
Q

what are some non-cardiac causes of troponin rise?

A

Pulmonary embolism
Sepsis
Renal failure
Sub-arachnoid haemorrhage

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16
Q

what is unstable angina?

A

unpredictable, rapidly worsening/ crescendo angina or angina at rest

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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.

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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

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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

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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
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21
Q

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

A

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

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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
which ECG readings give an indication of what is going on in the inferior of the heart?
SLL II, SLL III, aVF
26
which ECG readings give an indication of what is going on in the anterior of the heart?
V1, V2, V3, V4
27
which ECG readings give an indication of what is going on in the lateral side of the heart?
V5, V6
28
what portion of the heart is not covered by the normal ECG leads?
posterior
29
when might an MI not show up on an ECG?
if the occlusion occurs in the RCA or the left circumflex artery
30
if there is an occlusion of the RCA and a posterior MI occurs, what changes may be visible?
lateral changes
31
what is sort of chest pain is associated with MI?
- radiating to neck and arm - may not be "pain", more discomfort - severe but not agony - associated nausea, sweating and breathlessness
32
what are the risk factors for MI?
``` Male Age Known heart disease High blood pressure High cholesterol Diabetes Smoker Family history of premature heart disease ```
33
what is the order of investigations to diagnose MI?
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
with a STEMI what is the aim of treatment?
open coronary artery
35
what are the immediate treatments for STEMI?
1. get patient to cath lab for primary percutaneous coronary intervention 2. if cath lab not available, thrombolysis
36
what is the medication given to patients with STEMI and where a cath lab is not available?
tenecteplase given as a bolus
37
what are the risks of thrombolysis?
severe bleeding
38
when should thrombolysis not be carried out in someone with a STEMI?
recent previous stroke, previous intracranial bleed | or recent surgery, on warfarin or severe hypertensive
39
what is the general management of suspevted ACS?
Admit to hospital Cardiac monitor Give O2 only if levels low
40
what are the investigations that must be carried out for ACS?
-serial ECGs -Blood tests check not anaemic check kidney function cholesterol thyroid
41
which medications are given if patients with ACS get more chest pain?
GTN | opiates (eg. morphine)
42
what are the general types of medication given to patients with ACS?
``` anti-platelet drugs anti-thrombotic drugs Beta blockers statin ACE inhibitor ```
43
what anti-platelet drugs are given to patients with ACS and what doses?
aspirin-300mg loading dose then 75mg once a day | ticagrelor-180mg loading dose then 90 mg two times a day
44
what anti-thrombotic drug is given to patients with ACS and what doses?
fondaparinux- 2.5 mg once a day subcutaneously
45
what bets blocker is given to patients with ACS and what doses?
Bisoprolol 2.5 mg od
46
what statin is given to patients with ACS and what doses?
Simvastatin 40 mg od
47
what ACE inhibitor is given to patients with ACS and what doses?
Ramipril 1.25 mg bd
48
which patients with NSTEMI require a coronary angiogram?
patients at high risk
49
what are the risks of coronary angiography/angioplasty/stenting?
``` Bleeding Blood vessel damage Myocardial infarction Coronary perforation Stroke Dye can affect kidneys (“contrast nephropathy) ```
50
when is a coronary bypass graft performed?
- three vessel disease - left main stem disease - disease not amenable to PCI
51
what are the potential complications of MI
- Arrhythmia - Cardiogenic shock - Myocardial rupture - valve dysfunction due to papillary muscle dysfunction/rupture - acute ventricular septal defect
52
what must be carried out predischarge of an ACS patient?
Check on correct medications Address risk factors Cardiac rehabilitation Follow-up plans
53
what medication is given after a coronary stent is put in?
dual anti-platelet therapy for anything from 1 month to 12 months (to prevent thrombosis on stent before endothelium covers it)
54
what are the possible long term complications of a coronary stent?
- Higher risk of bleeding as on anti-platelet drugs - Increased risk of further myocardial infarction/death - Cardiac failure

Cardiovascular system (40 decks)

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