Cardiology 3 - Acute Coronary Syndrome

Question 1

left coronary becomes what

Answer 1

left anterior descending

circumflex

Question 2

right coronary supplies

Answer 2

broadly RHS of heart

right atrium
right ventricle
inferior left ventricle
posterior septum

Question 3

circumflex supplies

Answer 3

left atrium

posterior left ventricle

Question 4

left anterior descending supplies

Answer 4

anterior left ventricle

anterior septum

Question 5

3 types of ACS

Answer 5

unstable angina
STEMI
NSTEMI

Question 6

diagnosing ACS

Answer 6

1. do an ECG

if ST elevation or NEW left bundle branch block = STEMI

2. do troponin levels

if raised + ST depression / T wave inversion / pathological Q waves =
NSTEMI

if normal trop and non pathological ECG = unstable angina

Question 7

6 symptoms of MI

Answer 7

nausea and vomiting
central crushing chest pain + radiating jaw / arm pain
impending doom
short of breath 
palpitations

should last for >20 mins and not settle with rest

Question 8

who is at risk of silent MI

Answer 8

diabetics

Question 9

summarise ECG changes STEMI vs NSTEMI

Answer 9

STEMI
ST elevation, new LBBB

NSTEMI
pathological Q waves
T wave inversion
ST depression

Question 10

left coronary artery region and leads

Answer 10

anterolateral

I
aVL
V3-6

Question 11

left anterior descending region and leads

Answer 11

V1-4

Question 12

circumflex region and leads

Answer 12

I, aVL, V5-6

Question 13

right coronary region and leads

Answer 13

inferior

II, III, aVF

Question 14

when to do troponins

Answer 14

on arrival, serial at 6 or 12 hours

Question 15

5 other causes of raised troponins

Answer 15

chronic renal failure
sepsis
myocarditis 
aortic dissection
pulmonary embolism

Question 16

investigations for ACS

Answer 16

KEY - ECG, chest x ray, CT coronary angiogram

also - examine, FBC, UE, LFT, TFT, lipids, glucose/HbA1c

Question 17

acute STEMI treatment protocol

Answer 17

arrived within 12 hours of symptom onset

if <2 hours since in hospital, do PCI

if longer, do thrombolysis with alteplase

likely need loading with aspirin and ticagrelor too

Question 18

acute NSTEMI treatment

Answer 18

Beta  blockers unless can't
Aspirin 300mg stat
Ticagrelor 180mg stat
Morphine titrated
Anticoag - enox 1mg/kg BD
Nitrates

Question 19

how to assess for PCI with NSTEMI

Answer 19

Grace score - risk of death or repeat MI post NSTEMI

if >5% do PCI within 4 days

Question 20

6 complications of MI

Answer 20

death
rupture of papillaries
oedema
arrythmia, aneurysm
dressler's

Question 21

dressler’s syndrome

Answer 21

2-3 weeks post MI
immune response

pleuritic chest pain
low fever
pericardial rub

Question 22

diagnose and treat dressler’s

Answer 22

ECG global elevtion and T wave inversion

echo pericardial effusion

raised CRP ESR

gives NSAIDs or steroids if bad

Question 23

secondary prevention post ACS

Answer 23

aspirin 75mg
clopidogrel for up to 1 year 300mg then 75mg
atorvastatin 80mg
ACEx ramipril to 10mg
atenolol 25mg (10mg bisoprolol instead)
aldosterone antag if hearat failure (eplerenone 50mg)

do lifestyle advice too

Question 24

types of MI`

Answer 24

1 normal
2 induced by stressor
3 heart stops
4 procedure related