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02. Cardiovascular System > Atherosclerosis : ACS & AMI - Presentation & Investigation > Flashcards

Atherosclerosis : ACS & AMI - Presentation & Investigation Flashcards

1
Q

What does ACS stand for?

A

Acute coronary syndrome

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2
Q

What is acute coronary syndrome?

A

Any sudden event suspected or proven to be related to a problem with the coronary arteries

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3
Q

What is any sudden event suspected or proven to be related to a problem with the coronary arteries called?

A

Acute coronary syndrome

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4
Q

What is myocardial ischaemia?

A

Reduction in the blood supply to the heart muscle

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5
Q

What is reduction in the blood supply to the heart muscle called?

A

Myocardial ischaemia

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6
Q

What is 2?

A

Right coronary artery

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7
Q

What is 3?

A

Left anterior descending coronary artery

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8
Q

What is 4?

A

Circumflex coronary artery

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9
Q

What is 5?

A

Left coronary artery

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10
Q

What does AMI stand for?

A

Acute myocardial infarction

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11
Q

What is acute myocardial infarction?

A

Cell death due to ischaemia

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12
Q

What is cell death due to ischaemia called?

A

Acute myocardial infarction

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13
Q

What cause of death is heart disease in Scotland?

A

2nd most common cause of death

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14
Q

What can acute myocardial infarction be due to?

A

Complete or partial coronary artery occlusion

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15
Q

What is cardiac arrest?

A

Abnormal heart rhythm that is not compatible with life

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16
Q

What is an abnormal heart rhythm that is not compatible with life called?

A

Cardiac arrest

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17
Q

What are examples of cardiac arrest?

A

Ventricular fibrillation or tachycardia

Asystole

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18
Q

What is asystole?

A

Cardiac flatline so total state of cessation of electrical activity from the heart, more serious form of cardiac arrest and usually irreversible

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19
Q

What is a cardiac flatline, so total state of cessation of electrical activity from the heart called?

A

Asystole

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20
Q

When can cardiac arrest occur in relation to myocardial infarction?

A

Can occur during the acute phase or later afterwards

It may also be unrelated to myocardial infarction

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21
Q

What is a ‘heart attack’?

A

Public use to cover all manner of sudden cardiac onset

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22
Q

What is a word the public use to cover all manner of sudden cardiac events?

A

Heart attack

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23
Q

What do doctors usually think heart attack means?

A

Myocardial infarction

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24
Q

What is the process of the evolution of atherosclerosis?

A

1) Foam cells
2) Fatty streak
3) Intermediate lesion
4) Atheroma
5) Fibrous plaque
6) Complicated lesion/rupture

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25
Q

What is an example of chronic ischaemic heart disease vs examples of acute coronary syndrome?

A

Chronic ischaemic heart disease - stable angina

Acute coronary syndromes - unstable angina, myocardial infarction (STEMI and NSTEMI)

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26
Q

What is the difference in the blockage of arteries in chronic ischaemic heart disease and acute coronary syndromes?

A

Chronic ischaemic heart disease (such as stable angina) - less of lumen blocked

Acute coronary syndromes (such as unstable angina then myocardial infarction) - more of lumen blocked

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27
Q

How does complete coronary occlusion affect the ECG initially and after 3 days?

A

Initially - ST elevation

After 3 days - Q waves

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28
Q

How does partial coronary occlusion affect the ECG initially and after 3 days?

A

Initially - no ST elevation

After 3 days - no Q waves

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29
Q

How does the thickness of the damage to the heart muscle change for STEMI and NSTEMI?

A

NSTEMI - only partial thickness damage of the heart muscle

STEMI - full thickness damage of the heart muscle

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30
Q

What is other terminology for STEMI myocardial infarction?

A

Q wave MI

Transmural MI

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31
Q

What is other terminology for NSTEMI myocardial infarction?

A

Non Q wave MI

Subendocardial MI

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32
Q

What does the diagnosis of myocardial infarction require?

A

Detection of cardiac death/injury

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

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33
Q

How can cardia death/injury be detected?

A

Cardiac biomarkers

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34
Q

What are examples of different cardiac biomarkers?

A

Myoglobin

Troponin

CK-MB

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35
Q

Is more troponin present in STEMI or NSTEMI myocardial infarction?

A

STEMI

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36
Q

Does troponin increase always mean myocardial infarction?

A

No, there are many other causes

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37
Q

Other than myocardial infarction, what other things could cause an increase in troponin?

A

Pulmonary embolism

Cardiac contusion

Anaemia

Sepsis

Renal failure

Sub-arachnoid haemorrhage

38
Q

What is cardiac contusion?

A

Bruise of the heart muscle

39
Q

What is a bruise of the heart muscle called?

A

Cardiac contusion

40
Q

What are the different categories of myocardial infarction?

A

1

2

3

4a

4b

5

41
Q

What is a type 1 myocardial infarction?

A

Spontaneous MI associated with ischaemia adn due to primary coronary event

42
Q

What is a type 2 myocardial infarction?

A

Due to imbalance in supply and demand of oxygen, not ischaemia due to coronary event

43
Q

What is a type 3 myocardial infarction?

A

Sudden cardiac death, with symptoms of ischaemia accompanied by new ST elevation

Verified coronary thrombus after death

44
Q

What is a type 4a myocardial infarction?

A

MI associated with percutaneous coronary intervention

45
Q

What is a type 4b myocardial infarction?

A

MI associated with verified stent thrombosis via angiography or autopsy

46
Q

What is a type 5 myocardial infarction?

A

MI associated with CABG

47
Q

What could cause a type 1 myocardial infarction?

A

Coronary atherosclerosis

Coronary vasospasm

Coronary dissection

Embolism of material down coronary artery

Inflammation of coronary artery

Previous radiotherapy to chest causing fibrosis and stenosis of coronary arteries

48
Q

What could cause a coronary vasospasm?

A

Cocaine

Triptans

5-FU

49
Q

Who usually suffers from coronary dissection?

A

Younger, healthy females

50
Q

What could cause inflammation of coronary arteries?

A

Vasculitis

51
Q

What is seen in the history for acute coronary syndrome?

A

Chest pain (may radiate to neck/arm)

Nausea

Sweating

Breathlessness

52
Q

What are some risk factors for acute coronary syndrome?

A

Male

Age

Known heart disease

Known high blood pressure

High cholesterol

Diabetes

Smoker

Family history

53
Q
A
54
Q

Are males or females more at risk of acute coronary syndrome?

A

Males

55
Q

What are some examination findings for acute coronary syndrome?

A

Look completely fine or very unwell

No specific features to find

Ensure you check heart rate, blood pressure and listen for murmurs and crackles in the chest

56
Q

What are key investigations for acute coronary syndrome?

A

ECG

57
Q

What does an ECG tell you about acute coronary syndrome?

A

Where the problem is

58
Q

What are some different locations of myocardial infarction?

A

Lateral

Anterior

Posterior

59
Q

Why can posterior myocardial infarctions easily be missed?

A

No ECG leads on posterior chest

60
Q

What is a STEMI myocardial infarction caused by?

A

Completely occluded artery

61
Q

What does STEMI myocardial infarction cause?

A

Ongoing myocyte death

62
Q

What is the treatment for STEMI myocardial infarction?

A

Get coronary artery open as soon as possible:

Angioplasty (mechanical)

Thrombolysis (pharmacological)

63
Q

What are some risks of thrombolysis?

A

Bleeding

Don’t give if recent stroke or ever had a previous intracrainal bleed

Caution if recent surgery, on warfarin, severe hypertension

64
Q

When should thrombolysis never be given?

A

If had a recent stroke or ever had a previous intracranial bleed

65
Q

When does thrombolysis work best?

A

When given earlier

66
Q

What is generally the best option for treating STEMI myocardial infarction?

A

Angioplasty unless cannot get to the lab within 2 hours - then thrombolysis

67
Q

Compared to STEMI, what do NSTEMI patients tend to be?

A

Older

More likely to have previous MI

More likely to have other medical problems

68
Q

What are signs of unstable angina?

A

Rapidly worsening

Occuring at rest

ECG may be normal or abnormal

No cell death so troponins will not be raised

69
Q

What is the process of general management for acute coronary syndrome?

A

1) Admit to hospital
2) Cardiac monitor
3) Give oxygen only if levels are low

70
Q

What investigations are done for acute coronary syndrome?

A

ECG (consider doing posterior leads)

Blood tests (check troponin, Hb, kidney function and cholesterol)

71
Q

What should be check in blood tests for acute coronary syndrome?

A

Troponin

Haemoglobin

Kidney function

Cholesterol

72
Q

What is the treatment for acute coronary syndrome?

A

Glycerol trinitrate (GTN)

Opiates

Anti-thrombotic drugs

Beta blockers

Statin

ACE inhibitors

73
Q

What does GTN stand for?

A

Glycerol trinitrate

74
Q

What effect does glycerol trinitrate (GTN) have?

A

Vasodilator (opens up coronary arteries)

75
Q

How can GTN be administered?

A

Sublingual or IV infusion

76
Q

What is an example of an opiate?

A

Morphine

77
Q

Why are opiates given for acute coronary syndrome?

A

Relieves anxiety

Helps venodilate

78
Q

What are the different categories of anti-thrombotic drugs?

A

Anti-platelet drugs

Anti-coagulant drugs

79
Q

What are examples of anti-platelet drugs?

A

Aspirin

Clipidogrel

80
Q

What are examples of anti-coagulant drugs?

A

Heparin

Low molecular weight heparin (LMWH)

Fondaparinux

81
Q

Why are beta blockers used for acute coronary syndrome?

A

Reduces the work the heart has to do

82
Q

What do statins do?

A

Lower cholesterol

83
Q

Why are ACE inhibitors given for acute coronary syndrome?

A

Helps the heart muscle recover

84
Q

Do patients with an NSTEMI myocardial infarction always need a coronary angiogram?

A

They often do, use common sense

85
Q

What are some risks of coronary angiography and angioplasty/stenting?

A

Bleeding

Blood vessel damage

Myocardial infarction

Coronary perforation

Stroke

Dye affecting kidney function (contrast neuropathy)

86
Q

What does PCI stand for?

A

Percutaneous coronary intervention

87
Q

What does CABG stand for?

A

Coronary artery bypass graft

88
Q

What surgical options are there for revascularisation?

A

Percutaneous coronary intervention (PCI)

Coronary artery bypass graft (CABG)

89
Q

What are some possible complications following myocardial infarction?

A

Arrhythmia

Mechanical such as myocardial rupture, acute ventricular septal defect and mitral valve dysfunction due to papillary muscle rupture)

90
Q

What are some possible longer term consequences following myocardial infarction?

A

High risk of further myocardial infarction/death

Cardiac failure

Risk of bleeding as on anti-platelet drugs

Potential delay in getting other operations when on anti-platelet drugs

02. Cardiovascular System (72 decks)

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