Angina and Acute Coronary Syndromes

Question 1

In Angina you experience a ___ pain due to ____

Answer 1

visceral ; myocardial hypoxia

Question 2

Differentials for anginal pain:

Answer 2

oesophageal spasm, biliary colic, peptic ulcer, GORD, MSK, pericarditis, pleuritic pain

Question 3

angor animi =

Answer 3

fear of dying

Question 4

Reperfusion causes _____ and a ______ (which can cause ______)
both are a cause of death post-MI

Answer 4

arrhythmias

lengthened QT region -> polymorphic VT may lead to re-entrant tachycardias

Question 5

Post-MI can get cardiogenic shock if:

Answer 5

delayed presentation
multivessel disease
complications eg. mitral regurg, VSD, rupture

Question 6

Gold-standard test for ischaemic CVD

Answer 6

angiography - done before get angioplasty

anatomical and risk stratification

Question 7

Angiography involves inserting a catheter into the ___/___ into the _____ inject contrast and then ____

Answer 7

wrist/groin
coronary ostium
x-ray

Question 8

Non-invasive but less precise form of imaging the coronary arteries than angiography if calcium is present

Answer 8

CT angiography

Question 9

Anterior MI shows up as STE in _____ ECG leads

Reciprocal ST depression in ___

Answer 9

V1-6

III and avF

Question 10

Anteroseptal MI shows as STE in ____ ECG leads

Answer 10

V1-4

Question 11

Septal ECG leads =

Answer 11

V1-2

Question 12

Anterolateral MI shows STE in ____ ECG leads

Answer 12

avL, I, V3-6

Question 13

Inferior MI shows STE in ____ ECG leads

Answer 13

II III avF

Question 14

Lateral ECG leads =

Answer 14

I, avL, avR, V5, V6

Question 15

Inferior ECG leads =

Answer 15

II, III, avF

Question 16

Anterior leads =

Answer 16

V3-4

Question 17

Stable angina =

Answer 17

fixed stenosis
demand-led ischaemia
stop sit and GTN spray

Question 18

ACS = (3)

Answer 18

unstable angina
NSTEMI
STEMI

Question 19

ACS is ____ led ischaemia due to ___

Answer 19

supply-led

obstruction - subtototal/complete - dynamic stenosis

Question 20

old/new plaques are more likely to rupture due to ____ cap

Answer 20

new

thin fibrous cap

Question 21

Signs of MI that can be seen in an ECG

Answer 21

STE, T inversion, pathological Q waves

Question 22

Diagnosis of a STEMI needs

Answer 22

> =1mm STE in 2 adjacent limb leads
OR
=2mm STE in >=2 contiguous precordial leads

Question 23

Cardiac enzyme that peaks 24hr after MI

also in muscle and brain

Answer 23

CK - creatinine kinase

Question 24

Treatment of STEMI

Answer 24

MONAC
IV Morphine
O2 if hypoxic
Nitrate (GTN IV) if >90mmHg
Aspirin and clopidogrel 300mg
\+anti-emetic

Question 25

no acute complete occlusion of coronary vessel because plasmin performs intravascular thrombolysis =

Answer 25

NSTEMI

Question 26

ST depression indicates

Answer 26

ischaemia

Question 27

For NSTEMI treatment =

Answer 27

immediately - heparin long term - aspirin and clopidogrel for 3 months possibly tirofiban asap (outpatient) coronary angiogram and revascularisation

Question 28

Aim to defibrillate cardiac arrest within ___

Answer 28

3 minutes

Question 29

How to measure rate of irregular HR on ECG

Answer 29

no. QRS in 30 boxes x 10

Question 30

ECG leads that are normally inverted

Answer 30

avR, V1,2,3

Question 31

If ____ = left axis deflection

Answer 31

avF inverted

Question 32

If _____ = right axis deflection

Answer 32

I inverted

Question 33

If _____ = extreme right axis deflection

Answer 33

I and avF inverted

Question 34

To increase pre-load in cardiac arrest

Answer 34

IV fluid | raise legs

Question 35

No pulse, unresponsive and non-breathing

Answer 35

cardiac arrest

Question 36

Pulse, unresponsive and non-breathing

Answer 36

pulmonary arrest

Question 37

In cardiac arrest assess O2 delivery factors by :

Answer 37

ABG/pulse oximetry - SaO2 Full blood count - Hb ECG/pulse - HR

Question 38

CPR = ___compressions ___ deep at a rate of ___ then ___ rescue breaths lasting ___ Position =

Answer 38

30 compressions 5-6cm 100-120/min 2 breaths ; less than 10s middle of the chest

Question 39

Shockable heart rhythms

Answer 39

pulseless VT | VF

Question 40

Non-shockable heart rhythms

Answer 40

PEA | asystole

Question 41

ALS = | (___ -> __CPR ) repeat then on ___ shock give ___ and then after every alternative shock

Answer 41

Shock -> 2min 3rd adrenaline

Question 42

for PEA / asystole (may have p but no QRS) give __ adrenaline every ___mins/___cycles

Answer 42

1mg 3-5mins 2 cycles

Question 43

4Ts and 4Hs of reversible causes of cardiac arrest

Answer 43

hypoxia - hypovolaemia hypo/hyperkalaemia - hypothermia thrombosis - tension pneumothorax tamponade - toxins

Question 44

Bag ventilation / laryngeal mask airway (LMA) / supraglottic airway device (SAD) for

Answer 44

hypoxia in cardiac arrest

Question 45

After cardiac arrest transfer to ___

Answer 45

critical care area

Question 46

Cardiomalacia perforens =

Answer 46

mushy wall post MI and can burst => tamponade / septal defect

Question 47

To diagnose pathological pulmonary oedema must get patient to ___ and then listen to chest again

Answer 47

cough - post-pertussive inspiratory crackles | elderly get secretory crackles that go away when cough / move

Question 48

A(n) ____ infarction is caused by a blockage in the LAD | This shows as STE in leads ____

Answer 48

anteroseptal | V1-V4

Question 49

A(n) ____ infarction is caused by a RCA blockage | This shows as STE in leads ___

Answer 49

inferior | II III avF

Question 50

A(n) ___ infarction is caused by circumflex occlusion | Shows as____ on ECG

Answer 50

posterior | tall R and ST depression in V1-2

Question 51

PE most commonly causes ___ on ECG | Rarely causes characteristic _____

Answer 51

sinus tachy SIQIIITIII pattern - deep S waves in I pathological Q in III inverted T waves in III