Cardio - ACS ppt Flashcards
clinical syndrome usually characterized by episodes or paroxysms of pain or pressure in the anterior chest
Angina pectoris
factors pptating angina (5)
Physical exertion Exposure to cold Eating a heavy meal Stress or any emotion-provoking situation Sexual activity
Canadian cardiovascular society classification of angina:
angina evoked after walking <2 blocks
III
Canadian cardiovascular society classification of angina:
angina evoked with prolonged exertion
I
Canadian cardiovascular society classification of angina:
angina evoked with minimal activity
IV
Canadian cardiovascular society classification of angina:
angina evoked with rest
IV
Canadian cardiovascular society classification of angina:
angina evoked with walking >2blocks
II
An unprovoked prolonged episode of chest pain raising suspicion of AMI without definite ECG or laboratory evidence
unstable angina
chest pain suggestive of AMI with nonspecific ECG changes, (ST depression/T inversion/normal) with laboratory tests showing release of tropnonins
NSTEMI
sustained chest pain, acute ST elevation or new LBBB with release of troponins
STEMI
Arrange the following in the correct order A. Migration of monocyties B.Growth factors C. epithelial injury D. foam cells E. Atheromatous plaque forms
CADBE
Why is it possible for high grade stenoses to progress to complete occlusion but still do not precipitate acute STEMI?
due to collateral circulation
During development of plaques, abrupt transition can occur resulting in (3)
Platelet activation
Thrombin generation
Thrombus formation
What is the ultimate result of blood flow occlusion leading to imbalance between supply and demand?
a. Myocardial ischemia
b. Myocardial infarction
c. Myocardial necrosis
d. Myocardial apoptosis
C
This type of stenosis is likely to rupture causing thrombosis and STEMI
Less severe stenosis with lipid laden plaques and fragile caps
Caused by plaque formation, precipitated by stress or exertion, lasts <20min, relieved by NTG or resting
a. Stable angina
b. Unstable angina
c. NSTEMI
d. STEMI
A
platelet aggregation, chest paint at rest or minimal exertion, lasts >20min, often accompanied by other signs and symptoms, poor NTG relief. This is true for the following EXCEPT:
a. Stable Angina
b. Unstable Angina
c. NSTEMI
d. STEMI
A
what are the non-modifiable risk factors for ACS?
Increasing age
Gender (male)
Give 4 modifiable risk factors for ACS
Smoking Obesity Diet Lack of exercise High Serum Cholesterol Hypertension DM
Give 3 Respiratory ddx for chest pain
pulmonary embolism
pneumothorax
pneumonia
Give 3 GI ddx for chest pain
Esophageal spasm
GERD
Pancreatitis
Give 2 MSK ddx for chest pain
Costochondriasis
Trauma
Give 4 modifiable risk factors for ACS
Smoking Obesity Diet Lack of exercise High Serum Cholesterol Hypertension DM
Bedside investigations for ACS include (3)
Observation
ECG
BM
Blood investigations for ACS include (7)
FBC UE LFT lipids cardiac enzymes amylase CRP
Imaging investigations for ACS include
CXR
Normal troponin
a. UA
b. NSTEMI
c. STEMI
d. B and C
e. A and B
f. AOTA
A
Raised Troponin
a. UA
b. NSTEMI
c. STEMI
d. B and C
e. A and B
f. AOTA
D
ECG normal
a. UA
b. NSTEMI
c. STEMI
d. B and C
e. A and B
f. AOTA
A
ST depression
a. UA
b. NSTEMI
c. STEMI
d. B and C
e. A and B
f. AOTA
C
ST elevation
a. UA
b. NSTEMI
c. STEMI
d. B and C
e. A and B
f. AOTA
C
New LBBB
a. UA
b. NSTEMI
c. STEMI
d. B and C
e. A and B
f. AOTA
C
T inversion
a. hours
b. days
A
Q waves
a. hours
b. days
B
ST elevation is __mm in limb leads and __mm in chest leads
1mm, 2mm
II,III avF
Inferior
I aVL, V5, V6
lateral
V1-2
Septal
V3-4
Anterior
V5-6
Lateral
Right coronary involvement
a. Lateral
b. Anterior
c. Posterior
d. Inferior
D
Left Circumflex (or LAD) involvement
a. Lateral
b. Anterior
c. Posterior
d. Inferior
A
Left circumflex or right coronary artery involvement
a. Lateral
b. Anterior
c. Posterior
d. Inferior
C
LAD
a. Lateral
b. Anterior
c. Posterior
d. Inferior
B (or A)
II, III avF
a. Right coronary
b. Left circumflex (LAD)
c. LAD
d. Left circumflex or right coronary
A
V3-V4
a. Right coronary
b. Left circumflex (LAD)
c. LAD
d. Left circumflex or right coronary
C
I, aVL V5-6
a. Right coronary
b. Left circumflex (LAD)
c. LAD
d. Left circumflex or right coronary
B
V1-3 ST depression
a. Right coronary
b. Left circumflex (LAD)
c. LAD
d. Left circumflex or right coronary
D
Common ACS management meds
MONA morphine oxygen Nitrates Aspirin
dose of morphine in ACS
5-10 mg slow IV injection
ACS management: Nitrates GTN spray dose
400mcg = 1 spray
ACS management: Nitrates dose tablet
1mg
ACS management: Aspiring dose
300mg chewed
The following can be given in ACS management EXCEPT
a. morphine
b. oxygen
c. nitrates
d. aspiring
e. metoclopramide
f. NOTA
F
Unstable angina and NSTEMI meds (5)
LABN
LMWH
Aspirin
Beta Blocker
Nitrates
Predicts 6/12 mortality in NSTEMI patients
a. GRACE scoring
b. TIMI
A
Predicts Risk of cardiac events in next 30 days
a. GRACE scoring
b. TIMI
B
Door to balloon time in PCI for STEMI
120 min
PCI requires
a. aspirin 300 mg
b. clopidogrel 300 mg
c. both
d. neither
C
Door to needle time for thrombolysis in STEMI
90 min
Thrombolytic agents given in STEMI (3)
streptokinase
alteplase
tenecteplase
aspirin 300mg/ clopidogrel 300mg
a. PCI
b. Thrombolysis
c. both
d. neither
C
dose of aspirin for lifelong long-term management
75 mg OD
Dose of clopidogrel for 1 year
75 mg
How long should beta blockers be given
1 year to lifelong
Complications <72 hr (early)
Death cardiogenic shock heart failure ventricular arrhythmia myocardial rupture thromboembolism
Late complications (>72 hrs)
ventricular wall rupture valvular regurgitation ventricular aneurysms cardiac tamponade dresslers syndrome thromboembolism
