Acute coronary Syndromes - Presentation + Management

Question 1

Most common death cause in scotland

Answer 1

2. Heart disease

Question 2

What is acute coronary syndrome ( ACS)

Answer 2

• sudden collection of symptoms suspected to be related to a problem of the coronary arteries
• causes problems due to the effects of MI ( reduction in BS to myocardium)

Question 3

What is myocardial infraction?

Answer 3

-cell death due to prolonged ischaemia

Question 4

Causes of Myocardial infraction

Answer 4

-coronary HD

-

Question 5

What is cardiac arrest?

Answer 5

• abnormal heart rhythm not compatible with life

- ventricular fibrilation, ventricular tachycardia, asystole

Question 6

When can CA occur?

Answer 6

• during acute phase of MI
• after an MI ( due to the scar)
• can be unrelated

Question 7

State examples of chronic ischaemic heart disease

Answer 7

• stable angina

Question 8

State acute coronary syndromes

Answer 8

• unstable angina

- MI ( No ST elevation[NSTEMI]/ST elevation [ STEMI]

Question 9

ECG of a complete coronary occlusion vs partial coronary occlusion

Answer 9

Complete coronary occlusion > (Initial ECG) ST elevation > (After 3 days)Q waves

Partial coronary occlusion > (Initial ECG)No ST elevation >(After 3 days) No Q waves

Question 10

NSTEMI vs STEMI MI

Answer 10

NSTEMI

• partial thickness damage of myocardium
• noST elevation/ Q wave MI
• subendocardial MI

STEMI

• full thickness damage of myocardium
• ST elevation, Q wave MI
• transmural MI

Question 11

Diagnosis of MI

Answer 11

-Detection of cardiac cell death/injury using positive cardiac biomarkers

One of the following:

• symptoms of isachemia
• new ECG changes
• evidence of coronary problem on coronary angiogram/autopsy
• evidence of new cardiac damage on another test

Question 12

Describe how cardiac biomarkers work

Answer 12

• V High troponin indicates large infaction, STEMI (B1)

- elevated tropnonin, indicates NSTEMI ( B2)

Question 13

Non-coronary causes of troponin rise

Answer 13

• arrythmia
• pulmonary embolism
• cardiac contusion
• sepsis
• renal failure

Question 14

Causes of Type 1 MI

Answer 14

• atherosclerosis
• coronary vasopasm ( caused by cocoaine, triptans, anti-miggraine medication, 5-FU chemotherapy)
• coronary dissection ( younger females)
• embolism of material down coronary artery ( thrombus/tumour)
• inflammation of coronary arteries ( vasculitis)

Question 15

Presentation of ACS??

Answer 15

• chest pain that may radiate to neck/jaw/arm ( left)
• more of a ‘discomfort/pressure’ than pain
• severe but not ‘agony’
• nausea, sweating, breathlessness

Question 16

Cardiac risk factors

Answer 16

• male, age, HD
• HBP
• Hypercholesterlaemia
• diabetes
• smoker
• FMC of premature HD

Question 17

Examination of ACS

Answer 17

• may/may not look fine
• pale, sweaty
• listen for murmurs crackles. Check HR + BP

Question 18

Which coronary artery occlusion is more likely to be missed + why?

Answer 18

-Left main coronary artery occlusion due to little ECG change

Question 19

What MI will result from RCA, LAD, + Circumflex CA

Answer 19

RCA- Inferior MI
LAD CA- Anterior MI
Circumflex- Posterior MI

Question 20

Treatment of STEMI

Answer 20

• Reperfusion therapy
• primary PCI
• angioplasty
• thrombolyis