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ALS Theory > Cardiac Causes Of Cardiac Arrest > Flashcards

Cardiac Causes Of Cardiac Arrest Flashcards

1
Q

Definition of unstable angina?

A

One or more of:

Angina on exertion, occurring with increasing frequency, provoked by progressively less exertion (crescendo angina)

Angina-like pain without provocation by exercise, lasting few minutes

Unprovoked and prolonged episode of chest pain, without definite ECG or lab evidence of AMI

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2
Q

ECG changes in UA/NSTEMI?

A

Normal

TWI

ST segment depression

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3
Q

Does higher troponin level correlate with myocardium damage?

A

Yes

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4
Q

ECG Definition of STEMI?

A

ST elevation

New LBBB

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5
Q

Definitive management of STEMI?

A

PPCI

If unable to deliver within 120 minutes of onset of chest pain then fibrinolytic therapy should be considered

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6
Q

ECG - Anterior/Anterioseptal?
And corresponding artery?

A

Leads V1-4

LAD

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7
Q

ECG - Anteriolateral?

A

Leads V1-4 + Leads V5-6, I, aVL

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8
Q

ECG - inferior? And corresponding artery?

A

Leads II, III, aVF

Right coronary artery most commonly

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9
Q

ECG - Lateral? And corresponding artery?

A

V5-6, I, aVL

Circumflex artery or diagonal branch of LAD

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10
Q

ECG - posterior?

A

ST segment depression in anterior leads

Dominant R waves in V1/2

Right coronary artery

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11
Q

ECG - Brugada syndrome?

A

ST elevation in V1 and 2

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12
Q

Risk Assessments in ACS?

A

GRACE Score (admission and 6 month mortality)

  • Age
  • Signs of HF
  • HR at presentation
  • BP at presentation
  • Serum creatinine
  • ECG changes
  • Troponin level
  • Cardiac arrest at presentation
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13
Q

Management of ACS - all ACS immediate treatment?

A

Aspirin 300mg PO

SL GTN spray (unless hypotensive)

Oxygen (if hypoxic)

IV Morphine with antiemetic

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14
Q

Management of ACS - STEMI?

A

PPCI

+ Clopdiogrel 600mg/Ticagrelor 180mg prior to PPCI

Fibrinolytic Therapy
- Presentation within 12 hours of chest pain and PCI not possible within 120 minutes
- STE >2mm in 2 adjacent chest leads, >1mm in 2 or more adjacent limb leads, new onset LBBB, ST depression V1-3

Clopidogrel 300mg/Ticagrelor 180mg

LMWH/Fondaparinux/UFH

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15
Q

Treatment of NSTEMI?

A

Aspirin 300mg then 75mg OD
Clopidogrel/Ticagrelor/Prasugrel
Fondaparinux 2.5mg SC OD

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16
Q

Further management of NSTEMI?

A

Beta blocker
ACE inhibitor
Consider GTN infusion if angina recurs

17
Q

Subsequent management of ACS - UA low risk?

A

Early further non invasive imaging

18
Q

Subsequent management of ACS - NSTEMI and high risk UA?

A

Early PCI within 72 hours

19
Q

Secondary prevention in ACS?

A

Aspirin 75mg OD lifelong

Clopidogrel 75mg/Ticagrelor 90mg BD/Prasugrel 10mg OD for minimum 1 year

ACEi

Beta blocker

Atorvastatin 80mg ON

20
Q

ICD implantation - when is it indicated following ACS and when is it not?

A

Not indicated - arrhythmia occurs within 24-48 hours of confirmed ACS (unless severe LVSD 4 weeks post ACS)

Indicated - arrhythmia >48 hours post ACS unless associated with myocardial ischaemia which can be reversed by re-vascularisation

21
Q

Management of cardiac arrest in Cath lab?

A

If shockable (VF/VT), up to 3 stacked shocks should be attempted

If no ROSC following then standard ALS algorithm

Possible for PCI during CPR either by mechanical compression device or VA-ECMO

22
Q

Cardiogenic shock following ACS - management?

A

Inotropic support

Intra-Aortic balloon pump

Causes could be myocardial rupture, papillary muscle rupture, VSD

23
Q

Causes of SCD - and complications - Long QT Syndromes?

A

Inherited ion channel disorder

Predispose to torsades de pointes VT/VF

24
Q

Causes of SCD - and complications - acquired QT prolongation?

A

Drugs
IHD
Myocarditis

Predisposes to torsades de pointes VT/VF

25
Q

Causes of SCD - and complications -Brugada syndrome?

A

Inherited (AD) ion channel disorder

Most common in SE Asia

Risk of SCD higher in young males

26
Q

Causes of SCD - and complications - short QT syndrome

A

Inherited (AD) ion channel disorder

Predisposes to torsades de pointes VT/VF

27
Q

Causes of SCD - and complications - ARVC?

A

Inherited (AD)

Predisposes to VT/VF

ALS Theory (13 decks)

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