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Causes of cardiac arrest Flashcards

1
Q

How are the distinct categories of ACS initially recognised?

A

Presence or absence of ST elevation on an ECG
If no elevation then presence of a raised troponin

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2
Q

What does the rupture or erosion of an atherosclerotic plaque within a coronary artery cause?

A
  • acute thrombosis within the vessel lumen with often haemorrhagic extension into the plaque
  • contraction of smooth muscle cells within the artery wall resulting in vasoconstriction that reduces the lumen of the artery
  • associated partial or complete obstruction of the lumen, often with embolism of thrombus into the distal part of the vessel
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3
Q

What does an ECG show in a STEMI

A

ST elevation or new LBBB

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4
Q

What indicates a high risk NSTEMI

A

ST segment depression
Dynamic ECG changes
Unstable rhythm
Unstable haemodynamics
Diabetes
High GRACE score

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5
Q

What suggests myocardial damage in the section of the occluded artery?

A

Development of Q waves on ECG
Impairment of left ventricular function on ECHO

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6
Q

What is there an acute risk of in the initial phase of STEMI?

A

VF and VT

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7
Q

In a patient with suspected ACS how quickly should an ECG be performed?

A

10 minutes

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8
Q

What does the diagnosis of STEMI mandate?

A

PPCI within 120 minutes
If this cannot be achieved then fibrinolytic therapy should be considered
Reperfusion therapy should not be delayed while awaiting the results of a troponin

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9
Q

Anterior or anteroseptal infarction is seen in which leads? Which vessel does this correspond to?

A

V1-V4
LAD

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10
Q

Anterolateral infarct is seen in which leads?

A

V5-V6, I and aVL

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11
Q

Inferior infarction is seen in which leads?

A

II, III aVF. Lesion is in right coronary artery or the circumflex

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12
Q

Lateral infarction is seen in leads?

A

V5-V6 and/or aVL Caused by a lesion in the circumflex or diagonal branch of the LAD

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13
Q

How can posterior myocardial infarction appear on ECG?

A

reciprocal ST depression in anterior chest leads
usually due to right coronary artery occlusion but can be caused by dominant circumflex circulations

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14
Q

How can a posterior MI be confirmed?

A

By using posterior ECG leads- V8, V9, V10 should be placed in a horizontal line around the chest continuously

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15
Q

What can be used to detect right ventricular infarction?

A

Two dimensional echocardiography
Right sided precordial leads

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16
Q

The ST segment depression and T wave inversion that may occur in NSTEMI are ____related to the site of myocardial damage than the changes in STEMI

A

The ST segment depression and T wave inversion that may occur in NSTEMI are less-clearly related to the site of myocardial damage than the changes in STEMI

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17
Q

What conditions other than ACS may show ST segment depression/elevation

A

SAH or TBI

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18
Q

What might an ECG of someone with acute PE have?

A

TWI in leads V1-V4

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19
Q

What condition might cause ST elevation in lead V1 and V2?

A

Brugada syndrome

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20
Q

What other conditions may cause a raised troponin?

A
  • PE
  • aortic dissection
  • myocarditis
  • acute/chronic heart failure
  • arrhythmias
  • chronic renal failure
    -sepsis
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21
Q

What is directly linked to prognosis in someone with acute chest pain?

A

LV systolic function

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22
Q

What are some complications of AMI?

A

VSD
Severe mitral regurg

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23
Q

What are the variables used in GRACE score?

A
  • age
  • signs of heart failure
  • heart rate at presentation
  • bP at presentation
  • serum creatinine concentration
  • ECG changes
  • troponin concentration
  • cardiac arrest at presentation
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24
Q

What should be done if ACS is confirmed

A
  • connect patient to cardiac monitor
  • aspirin 300mg
  • GTN
  • pain relief
25
Q

For patients presenting with STEMI within __ of symptom onset, mechanical or pharmacological reperfusion must be achieved without delay

A

12h

26
Q

Call to balloon time

A

<120 minutes

27
Q

What should patients be given in addition to aspirin prior to PPCI?

A

Clopidogrel 600mg
Prasugrel 60mg (not if >75 years <60kg, history of bleeding or stroke)
Ticagrelor

28
Q

Give all patients receiving a fibrinolytic agent for STEMI:

A

Aspirin 300mg, ticagrelor 180mg loading doses, or if high bleeding risk aspirin 300mg and clopidogrel 300mg loading doses, or aspirin alone.

Antithrombin therapy
- LMWH IV bolus then sc OR
- UNFRACTIONATED heparin (full dose) OR
-fondaparinux

29
Q

What are the indications for immediate anti-fibrinolytic therapy in a presentation of AMI

A
  • presentation of AMI within 12 hours of symptom onset when PPCI is not possible within 120 minutes
  • ST segment elevation >0.2mV in 2 adjacent chest leads
  • > 0.1mV in 2 or more adjacent limb leads
  • Dominant R waves and ST depression in V1-V3
  • New onset LBBB
30
Q

What are the absolute contraindications to anti-fibrinolytic therapy?

A

Previous haemorrhagic stroke
ISchaemic stroke during the past 6 months
CNS damage or neoplasm
Recent (within 3 weeks) surgery, HI or major trauma
Active internal bleeding or GI bleeding within the past 6 months
Known or suspected aortic dissection
Known bleeding disorder

31
Q

In what percentage of patients receiving a fibrinolytic drug for STEMI is reperfusion not achieved?

A

20-30%

32
Q

When should you do an ECG after giving an anti-fibrinolytic

A

After 60-90 minutes

33
Q

What suggests failure of antifibrinolytic therapy?

A

Failure of ST-segment elevation to resolve by more than 50% compared with the pre-treatment ECGs

34
Q

What is not a reliable indication of reperfusion?

A

The patients symptoms

35
Q

What should be done in cases of failed reperfusion?

A

Transfer for PCI

36
Q

There is no role for anti-fibrinolytic therapy in which patients?

A

nstemi or ua

37
Q

What are the immediate treatment objectives for patients with UA or NSTEMI?

A

To prevent new thrombus formation
To reduce myocardial o2 demand

38
Q

How do you prevent new thrombus formation in patients with NSTEMI UA?

A

Fondaparinux 2.5mg OD
Aspirin 75mg daily after the initial 300mg loading dose

39
Q

Patients with NSTEMI or UA and are planned for angiography should be given what?

A

one of
Prasugrel 60mg then 10mg daily maintenance
Ticagrelor 180mg, then 90mg BD maintenance

40
Q

How can we reduce myocardial O2 demand?

A

Start beta-adrenoreceptor blockade
Consider diltiazem if B blockers contraindicated
Avoid dihydropyridine calcium channel blockers (nifedipine)
Consider IV nitrate if angina persists
Early introduction of an ACEi
Treat tahyarrhythmia or heart failure promptly

41
Q

What should patients with UA and a low grace score undergo?

A

Non invasive imaging

42
Q

What is appropriate in all patients post ACS?

A

Continues platelet inhibition- low dose aspirin 75mg daily for life
Clopidogrel for one year 75mg daily

43
Q

What can an ACE do after an ACS?

A

Reduce the remodelling that contributes to left ventricular dilatation and impairment, where there is LVSD ACE reduces the risk of heart failure and future AMI and death

44
Q

Tose with heart failure and reduces LVEF should also be offered (in addition to an ace)

A

Aldosterone antagonist

45
Q

What treatment should be started after an acs?

A

BETAblocker

46
Q

What is not indicated when an arrhythmia occurs within 24-48h of a confirmed ACS?

A

An ICD

47
Q

When is an iCD recommended?

A

When sustained ventricular arrhythmia occurs more than 24-48h after an acs as an inpatient (unless the arrythmia can be explained by ischaemia and resolved by revascularisation)

48
Q

Which types of arrest post ACS require an icd?

A

VF/pVT arrest as a late complication of MI or outside the context of an ACS

49
Q

What should you check for when an arrhythmia occurs in the context of an acs

A

Hypokalaemia, heart failure

50
Q

What does AF in the context of acs suggest?

A

left ventricular failure

51
Q

What should be considered if there is no response to atropine in a bradycardic patient with ACS?

A

Temporary cardiac pacing

52
Q

What should not be delayed in complete heart block in the context of inferior acs?

A

PPCI- heart block tends to resolve after this

53
Q

What does AV block suggest in a patient with acute anterior mi

A

extensive myocardial injury and poor prognosis- temporary cardiac pacing is usually needed

54
Q

What should be done if there is a VF/pVT arrest in the cath lab?

A

3 stacked shocks, if no ROSC then als algorithm should be followed

55
Q

How can CPR be carried out during PCI

A

ECMO or mechanical compression device

56
Q

What does cardiogenic shock consist of?

A

Hypotension
poor peripheral perfusion
pulmonary oedema
drowsiness
oliguria

57
Q

What should be considered when cardiogenic shock occurs after AMI

A

Myocardial rupture
papillary muscle rupture
VSD

58
Q

What reduces the risk of SCD in long QT syndrome

A

beta blockade and iCD

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