Cardio - ACS

Question 1

Acute Coronary Syndrome - what is it?

Answer 1

Umbrella term given to cover acute presentations of ischaemic heart disease: 1. STEMI 2. NSTEMI 3. Unstable angina

Question 2

Acute Coronary Syndrome - what are the symptoms and signs?

Answer 2

CHEST PAIN - central/left sided Radiates to left arm and jaw Pain radiating to jaw Palpitations Sweating Dyspnoea Nausea + vomiting Pale and clammy

Question 3

Acute Coronary Syndrome - investigations?

Answer 3

ECG Cardiac markers - troponin Bloods - FBC, U&Es

Question 4

Acute Coronary Syndrome - what is the treatment for high risk STEMI?

Answer 4

M - Morphine O - Oxygen N - Ntrates A - Aspirin T - Ticagrelor (or Clopidogrel) Only give O2 if Oxygen sats <94%

Question 5

Acute Coronary Syndrome - what is commonly given for pain relief?

Answer 5

Morphine GTN

Question 6

Acute Coronary Syndrome - what is done and given for treatment in an NSTEMI?

Answer 6

Assess risk using GRACE score If patient is deemed high risk - angiography within 72 hours, and administer GPIIa/IIIb antagonist infusion

If patient is deemed low risk - angiography at later date, and repeat troponin

Question 7

Acute Coronary Syndrome - what are GPIIa/IIIb antagonists?

Answer 7

GPIIb/IIIa antagonists inhibit platelet aggregation

Question 8

Acute Coronary Syndrome - what is the secondary prevention (lifelong management)?

Answer 8

Patients who’ve had an ACS require lifelong drugs - help lower risk of further event.

Standard therapy is the following as a minimum: 1. Beta blockers 2. Aspirin 3. ACE inhibitors 4. Statin

Question 9

Acute Coronary Syndrome - making a diagnosis

Answer 9

Patient presents with ACS symptoms

1. ECG - ST elevation or new LBBB, then STEMI
2. If no ST elevation, do troponin
3. Raised troponin and/or other ECG changes such as: ST depression T wave inversion Pathological Q waves DIAGNOSIS IS NSTEMI
4. Troponin levels normal and ECG no changes - unstable angina, or another cause e.g. MSK pain

Question 10

Acute Coronary Syndrome - which patients might suffer a ‘Silent MI’?

Answer 10

Diabetic patients Do not experience typical chest pain

Question 11

Acute Coronary Syndrome - which artery affects which heart area, and what ECG leads does it show up in?

Answer 11

Left Coronary Artery Anterolateral I,aVL, V3-6 LAD Anterior V1-4 Circumflex Lateral I, aVL, V5-6 Right Coronary Inferior II, III, aVF Artery