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cardiovascular system > Acute Coronary Syndromes Presentation and Management > Flashcards

Acute Coronary Syndromes Presentation and Management Flashcards

1
Q

Acute coronary syndrome

A

A sudden collection of symptoms suspected or proven to be related to a problem with the coronary arteries

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2
Q

Acute coronary syndrome can result in

A

Myocardial ischaemia anf infarction

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3
Q

Myocardial infarction

A

Cell death due to prolonged ischaemia

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4
Q

Chronic ischaemic heart disease

A

Stable angina

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5
Q

Acute coronary syndromes

A

Unstable angina

MI - STEMI and NSTEMI

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6
Q

Complete coronary occlusion initial ECG

A

ST elevation

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7
Q

Complete coronary occlusion ECG at 3 days

A

Q waves

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8
Q

Partial coronary occlusion initial ECG

A

No ST elevation

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9
Q

Partial coronary occlusion ECG at 3 days

A

No Q waves

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10
Q

STEMI

A

ST elevation MI

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11
Q

NSTEMI

A

Non-ST elevation MI

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12
Q

Diagnosis of MI is based on

A

Detection of cell death/injury via biomarkers and one of:

ECG changes, symptoms of ischaemia, coronary problem evidence via angiogram autopsy or other test

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13
Q

Cardiac biomarkers

A

Myoglobin
Troponin
CK-MB

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14
Q

Most important cardiac biomarker

A

Troponin

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15
Q

Troponin levels are significantly higher in which MI

A

Large infarction - STEMI

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16
Q

Non-coronary causes of troponin rise

A 
Arrhythmia
Pulmonary embolism
Cardiac contusion
Sepsis
Renal failure
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17
Q

Coronary problems that can lead to MI

A 
Atherosclerosis 
Coronary vasospasm
Coronary dissection
Embolism in coronary artery
Inflammation of coronary arteries (vasculitis)
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18
Q

MI type 1

A

Plaque rupture with thrombus

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19
Q

MI type 2

A

Vasospasm or endothelial dysfunction
Fixed atherosclerosis and supply-demand imbalance
Supply-demand imbalance alone

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20
Q

Chest pain associated with MI

A

Radiation to left arm and neck
Discomfort more than pain
Severe but not agony

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21
Q

Symptoms of MI

A

Chest pain
Nausea
Sweating
Breathlessness

22
Q

Cardiac risk factors

A 
Male
Age
Known heart disease
Hypertension
High cholesterol
Diabetes
Smoker
Family history
23
Q

Examination of MI

A

Heart rate
Blood pressure
Auscultation - murmurs or crackles
May look fine or unwell (STEMI)

24
Q

Key investigations for MI

A

ECG

Bloods - troponin, haemoglobin, kidney function, cholesterol

25
Q

Different ECG findings associated with MI

A 
ST elevation - emergency
No ST elevation
ST depression
T wave inversion
Normal
26
Q

Coronary artery involved in inferior MI

A

Right coronary artery

27
Q

Coronary artery involved with anterior MI

A

Left anterior descending coronary artery

28
Q

Coronary artery involved with posterior MI

A

Circumflex coronary artery

29
Q

Posterior MI ECG presentation

A

Opposite changes in the leads opposite those looking at that area (V1-V2)

30
Q

Treatment of STEMI (reperfusion therapy)

A

Mechanical - primary PCI, bypass

Pharmacological - thrombolysis

31
Q

Primary PCI

A

Percutaneous coronary intervention = angioplasty and stenting

32
Q

Thrombolysis

A

Tenecteplase (TNK)

33
Q

Action of thrombolysis

A

Dissolves blood clot in coronary artery

34
Q

Risk of thrombolysis

A

Bleeding

35
Q

Be cautious of thrombolysis if

A

Had recent stroke or previous intracranial bleed
Had recent surgery
On warfarin
Have severe hypertension

36
Q

Thrombolysis vs Cath lab

A

Cath lab as no risk of bleeding but waiting time is important. If long wait give thrombolysis and then transfer

37
Q

Signs that unstable angina and not MI

A

Rapidly worsening
Occurs at rest
ECG may be normal or abnormal
Troponin not raised

38
Q

Reason behind raised troponin

A

Myocardial cell death

39
Q

Management of suspected acute coronary syndrome

A

Admit to hopsital
Cardiac monitor
IV access
Give oxygen if levels low

40
Q

Treatment of acute coronary syndrome

A 
Glycerol trinitrate (GTN)
Opiates - morphine
Anti-platelet - aspirin
Anti-coagulant - heparin
Beta blocker
Statin
ACE inhibitor
41
Q

Glycerol trinitrate (GTN)

A

Vasodilator - opens up coronary arteries

42
Q

Opiates function

A

Painkillers

Also relieve anxiety and help venodilate

43
Q

Anti-platelet and anti-coagulant drugs function

A

Anti-thrombotic - stop platelets sticking together to prevent thrombosis

44
Q

Beta blockers function

A

Reduce work heart has to do

45
Q

Statin function

A

Lowers cholesterol levels

46
Q

Ace inhibitor function

A

Helps heart muscle recover

47
Q

Risks of coronary angiogram and PCI

A 
Bleeding
Blood vessel damage
MI
Coronary perforation
Stroke
Dye affecting kidney function
48
Q

Post-operation management

A 
Monitor heart
Echocardiogram
Auscultate for murmurs and signs of heart failure
Start drugs 
Look out for complications
49
Q

Mechanical complications of operation

A

Myocardial rupture - cardiac tamponade
Acute ventricular septal defect
Mitral valve dysfunction due to papillary muscle rupture

50
Q

Cardiac tamponade

A

Accumulation of fluid in pericardial space

51
Q

Pre-discharge management

A 
Check medications
Address risk factors
Smoking cessation
Arrange cardiac rehabilitation
Make plans for follow-up
52
Q

Longer term concerns most MI

A

Higher risk of bleeding and further MI/death
Cardiac failure
Late arrhythmias related to scar

cardiovascular system (27 decks)

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