Cardio week: Acute coronary syndrome and heart failure

Question 1

What 4 conditions/events are classified under ACS

Answer 1

• Stable angina
• Unstable angina
• NSTEMI
• STEMI

Question 2

What is given in acute management of MI

Answer 2

Morphine
Oxygen
Nitrate
Aspirin
Clopidogrel

Question 3

What test would confirm an MI

Answer 3

Troponin

Question 4

Main causes of heart failure

Answer 4

IHD
Hypertension
Valve/septal defects
Arrhythmias (especially Afib)

Question 5

Clinical features of acute Heart Failure

Answer 5

• SOB, tachypnoea
• tachycardia
• sweating
• raised JVP
• wet chest crepitations
• almost always abnormal ECG

Question 6

Clinical features of chronic heart failure

Answer 6

• tachycardia
• raised JVP
• wet chest crepitations
• displaced apex
• RV heave
• S3 sounds
• Odema, ascites

Question 7

Pulmonary oedema occurs in which heart failure patients

Answer 7

L sided heart failure

Question 8

Ankle oedema occurs in which heart failure patients

Answer 8

R sided heart failure

Question 9

Recognising heart failure on CXR (ABCDE)

Answer 9

• Alveolar oedema
• Kerley B lines (interstitial oedema)
• Cardiomegaly
• Dilated prominent upper lobe vessels
• E: Pleural effusion

Question 10

What is the best biomarker for diagnosing heart failure

Answer 10

BNP (brain natriuretic peptide)

• reflects myocyte stretch
• closely related to LV pressure

Question 11

Differentiating unstable angina from NSTEMI

Answer 11

NSTEMI will have raised troponin. Unstable angina will not.

Note that troponin may take 12h to become raised so cannot differentiate before then.

Question 12

In which group of patients might troponin be raised for a reason other than MI

Answer 12

CKD patients - do not excrete troponin as effectively