Cardiac Causes Of Cardiac Arrest Flashcards
Definition of unstable angina?
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
ECG changes in UA/NSTEMI?
Normal
TWI
ST segment depression
Does higher troponin level correlate with myocardium damage?
Yes
ECG Definition of STEMI?
ST elevation
New LBBB
Definitive management of STEMI?
PPCI
If unable to deliver within 120 minutes of onset of chest pain then fibrinolytic therapy should be considered
ECG - Anterior/Anterioseptal?
And corresponding artery?
Leads V1-4
LAD
ECG - Anteriolateral?
Leads V1-4 + Leads V5-6, I, aVL
ECG - inferior? And corresponding artery?
Leads II, III, aVF
Right coronary artery most commonly
ECG - Lateral? And corresponding artery?
V5-6, I, aVL
Circumflex artery or diagonal branch of LAD
ECG - posterior?
ST segment depression in anterior leads
Dominant R waves in V1/2
Right coronary artery
ECG - Brugada syndrome?
ST elevation in V1 and 2
Risk Assessments in ACS?
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
Management of ACS - all ACS immediate treatment?
Aspirin 300mg PO
SL GTN spray (unless hypotensive)
Oxygen (if hypoxic)
IV Morphine with antiemetic
Management of ACS - STEMI?
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
Treatment of NSTEMI?
Aspirin 300mg then 75mg OD
Clopidogrel/Ticagrelor/Prasugrel
Fondaparinux 2.5mg SC OD
Further management of NSTEMI?
Beta blocker
ACE inhibitor
Consider GTN infusion if angina recurs
Subsequent management of ACS - UA low risk?
Early further non invasive imaging
Subsequent management of ACS - NSTEMI and high risk UA?
Early PCI within 72 hours
Secondary prevention in ACS?
Aspirin 75mg OD lifelong
Clopidogrel 75mg/Ticagrelor 90mg BD/Prasugrel 10mg OD for minimum 1 year
ACEi
Beta blocker
Atorvastatin 80mg ON
ICD implantation - when is it indicated following ACS and when is it not?
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
Management of cardiac arrest in Cath lab?
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
Cardiogenic shock following ACS - management?
Inotropic support
Intra-Aortic balloon pump
Causes could be myocardial rupture, papillary muscle rupture, VSD
Causes of SCD - and complications - Long QT Syndromes?
Inherited ion channel disorder
Predispose to torsades de pointes VT/VF
Causes of SCD - and complications - acquired QT prolongation?
Drugs
IHD
Myocarditis
Predisposes to torsades de pointes VT/VF
Causes of SCD - and complications -Brugada syndrome?
Inherited (AD) ion channel disorder
Most common in SE Asia
Risk of SCD higher in young males
Causes of SCD - and complications - short QT syndrome
Inherited (AD) ion channel disorder
Predisposes to torsades de pointes VT/VF
Causes of SCD - and complications - ARVC?
Inherited (AD)
Predisposes to VT/VF
