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02. Cardiovascular System > Acute Coronary Syndromes & Management > Flashcards

Acute Coronary Syndromes & 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 biomarkers2. 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 embolismSepsisRenal failureSub-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 depressionT 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

MaleAgeKnown heart diseaseHigh blood pressureHigh cholesterolDiabetesSmokerFamily history of premature heart disease

33
Q

what is the order of investigations to diagnose MI?

A
  1. symptoms- ACS or not2. ECG to look for ST elevation or not3. 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 intervention2. 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 bleedor recent surgery, on warfarin or severe hypertensive

39
Q

what is the general management of suspevted ACS?

A

Admit to hospitalCardiac monitorGive O2 only if levels low

40
Q

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

A

-serial ECGs-Blood testscheck not anaemiccheck kidney functioncholesterolthyroid

41
Q

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

A

GTNopiates (eg. morphine)

42
Q

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

A

anti-platelet drugsanti-thrombotic drugsBeta blockersstatinACE 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 dayticagrelor-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

BleedingBlood vessel damageMyocardial infarctionCoronary perforationStrokeDye 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 medicationsAddress risk factorsCardiac rehabilitationFollow-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

02. Cardiovascular System (72 decks)

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