Acute Coronary Syndromes: Presentation & Management

Question 1

How significant is coronary heart disease in terms of deaths in Scotland?

Answer 1

2nd highest cause in deaths in Scotland

Question 2

What are the two things which influence coronary heart disease?

Answer 2

Genetics
Lifestyle

Question 3

What is an acute coronary syndrome?

Answer 3

New onset of a collection of symptoms related to a problem with the coronary arteries

Question 4

Which tissue does the coronary arteries supply?

Answer 4

Heart muscle- myocardial cells

Question 5

What does an acute coronary syndrome cause?

Answer 5

Myocardial ischaemia

Question 6

What can prolonged ischaemia cause?

Answer 6

Myocardial infarction

Question 7

Give two examples of conditions which fall under the category of acute coronary syndromes.

Answer 7

MI
Unstable angina

Question 8

Compare an acute coronary syndrome to stable angina.

Answer 8

Unpredictable
May occur at rest

->angina is not present at rest, only upon exertion.

Question 9

RECAP- name the three levels of bloods vessels

Answer 9

Intima (internal)
Media
Adventitia (external)

Question 10

What does a fibrous cap serperate?

Answer 10

Blood and fatty material

Question 11

In acute coronary syndromes, the plaques are unstable.
What does this mean?

Answer 11

Fibrous layer is thin- blood may get exposed to the fatty material

Question 12

RECAP- what can form when the blood and fatty acid make contact?

Answer 12

A thrombus

Question 13

What are the indicators of cardiac cell death?

Answer 13

Elevation of cardiac biomarkers

AND one of:
symptoms of ischaemia
new ECG changes
evidence of coronary problem on coronary angiogram or autopsy
evidence of new cardiac damage on another test

Question 14

What does troponin do in cardiac cells?

Answer 14

Connects actin and myosin
Calcium regulator for cardiac muscle contraction

Question 15

What are some of the non-cardiac causes of troponin rises?

Answer 15

Sepsis
Anaemia

Question 16

What are some of the cardiac causes of troponin rises?

Answer 16

Arrhythmia
Pulmonary embolism
Cardiac contusion

Question 17

What is type 1 MI?

Answer 17

Spontaneous MI associated with ischaemia
Due to a primary event like plaque erosion, rupturing, fissuring or dissecting

Question 18

What is a type 2 MI?

Answer 18

Due to an imbalance in the supply and demand of oxygen.
Result of ischaemia but NOT ischaemia from thrombosis of the coronary artery.

Question 19

How do acute coronary syndromes typically present?

Answer 19

Chest pain
-> important in history to find out more about the pain

Question 20

RECAP- what are some of the cardiac risk factors?

Answer 20

Male
Age
Known heart disease
High blood pressure
High cholesterol
Diabetes
Smoker
Family history of premature heart disease

Question 21

What symptoms may indicate issues with LV function?

Answer 21

Swollen ankles or elevated venous pressure

Question 22

What investigations are carried out for someone with suspected acute coronary syndrome?

Answer 22

12 lead ECG
Bloods

Question 23

Which segment of the ECG is important in the assessment of patients with ischaemic heart disease?

Answer 23

ST segment

Question 24

What happens of ECG is a coronary artery is completely occluded?

Answer 24

Elevation of ST segment

Question 25

Name the two types of reperfusion therapy.

Answer 25

Mechanical Phrarmacological

Question 26

Give an example of mechanical reperfusion therapy.

Answer 26

Balloons and stent

Question 27

Give an example of pharmacological reperfusion therapy.

Answer 27

Strong blood thinners

Question 28

What is the purpose of reperfusion therapy?

Answer 28

Restores blood flow

Question 29

Give an example of a strong blood thinning medication which can dissolve clots.

Answer 29

Thrombolysis

Question 30

What is one of the risks of thrombolysis?

Answer 30

Bleeding

Question 31

When would you not give a patient thrombolysis?

Answer 31

If they have had a recent stroke or ever had an intracranial bleed.

Question 32

When would you be cautious about giving a patient thrombolysis?

Answer 32

If they have had recent surgery, are on warfarin or have server hypertension.

Question 33

What is the general rule for treatment of a STEMI?

Answer 33

If cath lab is less than two hours away, go there. If not, use thrombolysis.

Question 34

What is one thing to remember when doing an ECG?

Answer 34

Consider if you should put leads on the back

Question 35

What does glycerol tinitrate do?

Answer 35

It is a vasodilator Will not help if artery is fully blocked

Question 36

Which drug is commonly giving to stop blood clotting?

Answer 36

Aspirin

Question 37

Which enzyme does aspirin inhibit?

Answer 37

COX-1 hehe

Question 38

Which two types of anti-coagulant drugs are given to those with acute coronary syndromes?

Answer 38

Dual anti-platelet therapy Anti-coagulant drugs

Question 39

What drugs fall under dual anti platelet therapy?

Answer 39

Aspirin PLUS ONE OF: Clopidogrel Ticagrelor Prasugrel

Question 40

Which drugs fall under the anti-coagulant drugs?

Answer 40

Heparin LMWH Fondaparinux:

Question 41

What do beta blockers do?

Answer 41

Reduce sympathetic drive so heart doesn't have to work as hard Reduces risks of further cardiac events in the long term.

Question 42

What do statins do?

Answer 42

Lower cholesterol

Question 43

What do ACE inhibitors do?

Answer 43

Help muscle to recover

Question 44

What are some of the risks of coronary angiograms and PCI?

Answer 44

Bleeding from arterial access site- less so on radial Myocardial infarction Coronary perforation Emergency CABG Stroke Dye can affect kidney function

Question 45

What do you do in patients with ventricular fibrillation?

Answer 45

Shock them with a defibrillator or they will die

Question 46

What are some mechanical complications of those with acute coronary syndrome?

Answer 46

Myocardial rupture - bleed into pericardium – causes cardiac tamponade Acute Ventricular Septal Defect Mitral valve dysfunction due to papillary muscle rupture