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Cardiovascular System > Acute Coronary Syndromes:Presentation and Management > Flashcards

Acute Coronary Syndromes:Presentation and Management Flashcards

1
Q

What is an Acute Coronary Syndrome?

A

• Any sudden event suspected or proven to be related to a problem with the coronary arteries, which can arise due to myocardial iscahaemia

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2
Q

What is a Myocardial Infarction

A

Death due to ischaemia and can be partial or complete occlusion of coronary artery

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3
Q

What is a cardiac arrest

A

Abnormal heart rhythm not compatible with life such as VF, tachycardia, asystole

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4
Q

When can cardiac arrest occur (3)

A

During acute phase of MI
Late after an MI
Unrelated to MI

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5
Q

Chronic Ischaemic Heart Disease

A

• Stable angina

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6
Q

Acute Coronary Syndromes (2)

A

• Unstable angina
• Myocardial infarction (plaque disruption and platelet aggregation:
-NSTEMI
-STEMI

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7
Q

Initial ECG of transmural MI and after 3 days

A

ST elevation and Q wave

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8
Q

Initial ECG of subendocardial MI and after 3 days

A

No ST elevation and no Q wave

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9
Q

Diagnosis of MI (5)

A

Detection of cell death or injury (troponin)
 Symptoms of ischemia
 New ECG changes
 Evidence of coronary problem on coronary angiogram or autopsy
 Evidence of new cardiac damage on another test

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10
Q

Non-coronary causes of troponin rise (6)

A 
Pulmonary embolism
Cardiac contusion
Anaemia
Sepsis
Renal failure
Sub-arachnoid haemorrhage
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11
Q

Type 1 MI

A

Spontaneous

Associated with ischaemia due to plaque erosion, rupture, fissuring or dissection

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12
Q

Type 2 MI

A

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

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13
Q

Type 3 MI

A

Sudden cardiac death
Symptoms of ischaemia
ST elevation
LBBB

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14
Q

Type 4a MI

A

Associated with percutaneous coronary intervention- increase biomarkers 3 X 99th percentile of the upper reference limit

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15
Q

Type 4b

A

MI associated with verified stent thrombosis via angiography

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16
Q

Type 5 MI

A

MI associated with CABG (plus new Q waves or LBBB or imagine evidence of new loss)

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17
Q

Causes of type 1 MIs not related to coronary atherosclerosis (5)

A 
Coronary vasospasm
Coronary dissection
Embolism of material
Inflammation
Previous radiotherapy
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18
Q

Causes of coronary vasospasm

A

Cocaine, triptans, 5-FU

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19
Q

Embolism of material

A

Thrombus or tumour

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20
Q

Inflammation of coronary arteries is known as

A

Vasculitis

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21
Q

Previous radiotherapy to chest causes

A

Fibrosis and stenosis or coronary arteries

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22
Q

Presentation of ACS (5)

A 
Chest pain
May radiate to neck and arm
More discomfort than pain
Severe but not in agony
May be associated with nausea, sweating and SOB
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23
Q

Cardiac Risk Factors (8)

A
  • Male
  • Age
  • Known heart disease
  • High BP
  • High cholesterol
  • Diabetes
  • Smoker
  • Family history of premature heart disease
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24
Q

Examination (5)

A
  • May look unwell
  • May look completely fine
  • Often no specific features to find
  • Check HR, BP
  • Listen for murmurs, crackles in chest
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25
Q

Key investigation

A

ECG

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26
Q

T wave in NSTEMI

A

T wave inverted

27
Q

T wave in STEMI

A

hyper-acute T waves

28
Q

what occlusion is easily missed

A

LCx

29
Q

Anterior MI ECG

A

V1-V4

30
Q

Lateral MI ECG

A

V5-V6

31
Q

Inferior MI ECG

A

II, III, aVF

32
Q

High Lateral MI ECG

A

I, aVL

33
Q

Posterior MI

A

V1-V2 (opposite changes in the leads opposite those looking at that area)- some inferior ST elevation

34
Q

Diagnosis

A

Symptoms
ST elevation?
Troponin elevation
Q wave?

35
Q

Typical angina for >20 minutes

A

yes- Acute coronary syndrome

No- stable angina

36
Q

ST elevation

A

Yes- STEMI

No- test troponin level

37
Q

Troponin elevated

A

Yes- NSTEMI

No- unstable angina

38
Q

After 3 days Q wave?

A

Yes- QwMI

No- MQMI

39
Q

Posterior ECG leads

A

V7, V8, V9

40
Q

Inferior MI

A

RCA

41
Q

Anterior MI

A

Left anterior descending coronary artery

42
Q

Lateral MI

A

Circumflex coronary artery

43
Q

Mechanical Reperfusion therapy

A

Angioplasty and stenting in cath lab

44
Q

Pharmacological Reperfusion Therapy

A

Thrombolysis (Tenecteplase)

45
Q

Risks of Thrombolysis

A 
Bleeding
Recent stroke/intracranial bleed
Recent surgery
On Warfarin
Sever Hypertension
46
Q

During STEMI within 2 hours what treatment can you give

A

PCI

47
Q

During STEMI after 2 hours what treatment can you give

A

Thrombolysis then transfer

48
Q

NSTEMi compared to STEMI (4)

A

Seen in older patients
Previous CABG/MI/PCI
More likely to have medical problems
Presentation may not be obvious or clear

49
Q

Signs and symptoms during unstable angina (5)

A 
Convincing anginal symptoms
Rapidly worsening (crescendo)
Occurring at rest
ECG may be normal or abnormal
No cell death so troponin is not elevated
50
Q

General management of ACS

A

Hospitalisation
Cardiac monitoring
Oxygen if levels are low

51
Q

Investigations

A

ECGs
Posterior leads
Blood tests (troponin, kidney, Hb, cholesterol)

52
Q

Treatment

A

GTN (vasodilators)- sublingual IV infusion

Opiates (morphine) reduce anxiety venodilator

53
Q

Anti-thrombotic drugs (anti-platelet) (3)

A

Aspirin
Clopidogrel
Ticagrelor

54
Q

Anti-coagulant drugs (3)

A

LMWH
Unfractionated Heparin
Fondaparinux

55
Q

Other Drugs

A

Beta Blockers

ACEI

56
Q

Do patients with NSTEMI also need a coronary angiogram (2)

A

Ideally within 48 hours

Use risk calculator to assess risk

57
Q

Risks of coronary angiography and angioplasts/stents (6)

A 
Bleeding
Blood vessel damage
MI
Coronary perforation
Stroke
Contrast nephropathy
58
Q

What is CABG used to treat (2)

A

3 vessel disease

Left main stem disease

59
Q

Management in hospital (3)

A

Home within 3-4 days
Keep monitor for first 24-48 hours
Get an echo

60
Q

Course in Hospital (2)

A

Listen for murmurs and signs of HF

Secondary prevention drugs

61
Q

Complications following an MI (4)

A

Arrhythmia
Myocardial rupture
Acute ventricular septal defect
Mitral valve dysfunction due to papillary muscle rupture

62
Q

Pre-discharge arrangements (5)

A 
Check correct medications
Address risk factors
Smoking cessation
Arrange cardiac rehabilitation
Make follow up plans
63
Q

Anti-platelet therapy precautions(4)

A

Takes time for stent to become endothelised into coronary artery wall
Blood exposed to metal stent can thrombose and block off stent
Antiplatelets required for 1-12 months
Premature discontinuation can be fatal

64
Q

Longer term complications

A

High risk of future MI/death
Cardiac failure
Risk of bleeding (anti-platelets)
Will have to delay other operations due to being on antiplatelet drugs

Cardiovascular System (42 decks)

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