[Cardio] Acute Coronary Syndrome

Question 1

pt has chest pain. ECG shows ST elevation or new LBBB. Dx?

Answer 1

STEMI

Question 2

pt has chest pain. ECG shows no ST elevation and raised troponin. Dx?

Answer 2

NSTEMI

Question 3

pt has chest pain. ECG shows no ST elevation and no raised troponin. Dx?

Answer 3

unstable angina

Question 4

what is the initial mx for all ACS?

Answer 4

• IV opiate analgesia
• antiemetics
• aspirin 300mg
• O2 only if hypoxic (spO2 <94%)
• (+) GTN infusion for uncontrolled pain / severe HTN / pulmonary oedema

Question 5

how do you manage a STEMI?

Answer 5

1. primary PCI

2. thrombolysis (+PCI if signs of continuing ischaemia)

Question 6

how do you manage a non-ST elevation ACS (NSTEMI and unstable angina)?

Answer 6

1. medical mx – DAPT
   - aspirin + clopidogrel / ticagrelor
   - fondaparinux
2. risk stratification – GRACE score
   - high risk → PCI within 96 h of admission

Question 7

what is the mx post-ACS?

Answer 7

1. cardiac rehabilitation
2. lifestyle changes
3. medication

Question 8

what is included in ‘lifestyle changes’ for mx post-ACS?

Answer 8

• diet
• exercise
• smoking cessation
• weight mx

Question 9

what is included in ‘medications’ for mx post-ACS?

Answer 9

• DAPT (Aspirin + Clopidogrel / Ticagrelor) for 1-12m followed by aspirin lifelong
• BB
• ACEi
• statin

Question 10

what is type 1 MI?

Answer 10

acute plaque rupture

Question 11

type is type 2 MI?

Answer 11

supply over demand mismatch

Question 12

what is the ST elevation ECG criteria?

Answer 12

> 1mm ST↑ at J-point in 2 continuous leads
OR
2mm ST↑ in leads V2-V3

Question 13

what are the complications post-MI?

Answer 13

DARTH VADER:

Death
Arrhythmia / heart block
Ruptured LV aneurysm
Thrombus
Heart failure

VSD
Another MI
Dressler's syndrome
Embolus
Regurgitant valve

Question 14

what is Dressler’s syndrome?

Answer 14

autoimmune pericarditis, weeks-months after acute MI

Question 15

how does Dressler’s syndrome present?

Answer 15

pleuritic chest pain and fever

Question 16

what do ECG changes for Dressler’s syndrome show?

Answer 16

global ST elevation and PR depression

Question 17

how does LV aneurysm after an acute MI present?

Answer 17

heart failure or arrhythmia

Question 18

what do ECG changes for LV aneurysm show?

Answer 18

persistent ST elevation

Question 19

what are features of cardiogenic shock?

Answer 19

cold peripheries and poor urine output

Question 20

what should pts who have undergone PCI with stents receive and for how long?

Answer 20

DAPT for at least 12 months

Question 21

what would bradycardia and AV nodal block hint at?

Answer 21

inferior MI