Acute coronary syndromes and myocardial infarctions

Question 1

How can you differentiate between stable angina and acute coronary syndrome?

Answer 1

ACS - symptoms at rest, incomplete improvement with GTN

Angina - not at rest, complete improvement with GTN

Question 2

Describe some non-modifiable risk factors for coronary artery disease

Answer 2

Age
Gender
Creed
Family history and genetic factors

Question 3

Describe some modifiable risk factors for coronary artery disease

Answer 3

Smoking
Diabetes mellitus (glycaemic control)
Hyperlipidaemia
Hypertension
Lifestyle - exercise and diet

Question 4

What type of MI is most associated with unstable angina?

Answer 4

NSTEMI

Question 5

Describe some ECG changes in those with unstable angina and NSTEMI

Answer 5

ST depression
ST elevation transiently
T wave inversion

Must do serial ECGs to not miss delayed changes

Question 6

What are the immediate treatments for unstable angina or NSTEMI

Answer 6

ABCDE then MONA

M - morphine or diamorphine
O - oxygen
N - nitroglycerine
A - aspirin

Question 7

What is cardiac troponin?

Answer 7

A complex of three regulatory proteins (troponin C, troponin I, and troponin T) that is integral to muscle contraction (except not in smooth muscle). Biomarker of myocardial damage as normally only intracellular.

Question 8

In what period of time is PCI most effective following a STEMI?

Answer 8

120-150 mins from call for help

(call to balloon time)

Question 9

In what period of time is fibrinolytic therapy most effective following a STEMI?

Answer 9

90 mins after call for help

30 mins after arrival at hospital

Question 10

What % of those survive sudden cardiac death?

Answer 10

2%

Question 11

What are the three main mechanical complications found following an MI?

Answer 11

Free wall rupture
Papillary muscle rupture
Rupture of IVS (VSD)

Question 12

What are the two main groups of complications seen following an MI?

Answer 12

Mechanical complications

Ventricular arrhythmic complications

Question 13

What is the difference between STEMI and NSTEMI?

Answer 13

STEMI - complete coronary occlusion, ST elevation, Q waves 3 days later

NSTEMI - partial coronary occlusion, no ST elevation or Q waves

Question 14

What are some non-cardiac causes of troponin rise?

Answer 14

Pulmonary embolism
Sepsis
Renal failure
Sub-arachnoid haemorrhage

Question 15

If patient with STEMI is brought in fast, do they get PCI or thrombolysis first?

Answer 15

PCI