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Coronary artery disease Flashcards

1
Q

What is the pathophysiology in brief of acute coronary syndromes?

A

Plaque rupture, thrombosis, inflammation

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2
Q

Differential for acute coronary syndrome?

A 
  Angina 
  Peri / endo / myocarditis 
  Dissection 
  PE, pneumothorax, pneumonia 
  Costochondritis 
  GI: e.g. GORD, spasm 
  Anxiety
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3
Q

What are the three divisions of ACS?

A

unstable angina
NSTEMI
STEMI

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4
Q

What are the features of NSTEMI on ECG?

A

ST depression and T wave inversion

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5
Q

When is the peak of troponin rise in MI?

A

24 hour

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6
Q

At what time period do you need to repeat troponin?

A

Trop elevated 3-12 hr, peaks at 24hr

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7
Q

What is the treatment for NSTEMI/UA?

A

medical

elective angio +- PCI/CABG

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8
Q

What is PCI?

A

Percutaneous Coronary Intervention (PCI, formerly known as angioplasty with stent) is a non-surgical procedure that uses a catheter (a thin flexible tube) to place a small structure called a stent to open up blood vessels in the heart that have been narrowed by plaque buildup, a condition known as atherosclerosis.

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9
Q

What is CABG?

A

Coronary artery bypass surgery restores normal blood flow to the heart by creating a “detour” (bypass) around the blocked artery/arteries. This is done by using a healthy blood vessel, called a graft. Grafts usually come from your own arteries and veins located in the chest, leg or arm. The graft creates a new pathway to carry oxygen-rich blood to the heart.

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10
Q

List four complications of MI

A 
Death
Pericarditis
Dressler's syndrome
Arrythmias
Pump failure
Embolism
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11
Q

What is the viability time frame of PCI?

A

<12 hr

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12
Q

Two complications of PCI?

A

bleeding, arrhythmia, emboli

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13
Q

What is the ECG criteria for thrombolysis?

A

ST elevation >2 chest leads or >2 limb leads

New LBBB

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14
Q

What are the contraindications for thrombolysis in STEMI?

A 
AGAINST
 Aortic dissection 
 GI bleeding 
 Allergic reaction previously 
 Iatrogenic: recent surgery 
 Neuro: cerebral neoplasm or CVA Hx 
 Severe HTN (200/120) 
 Trauma, inc. CPR
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15
Q

Two complications of thrombolysis?

A

bleeding
stroke
arrhythmia
allergic reaction

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16
Q

Secondary management of MI?

A

 ACEi: start w/i 24hrs of MI (e.g. lisinopril 2.5mg)
 β-blocker: e.g. bisoprolol 10mg OD (or, CCB)
 Cardiac rehabilitation (group exercise and info) / Heart Manual
 DVT prophylaxis until fully mobile
 Continue for 3mo if large anterior MI
 Statin: regardless of basal lipids (e.g. atorvastatin 80mg)

17
Q

What lifestyle advice would you offer for patient post-MI?

A 
 Stop smoking 
 Diet: oily fish, fruit, veg, ↓ sat fats 
 Exercise: 30min OD 
 Work: return in 2mo 
 Sex: avoid for 1mo 
 Driving :avoid for 1mo
18
Q

Patient with NSTEMI. What is their inpatient management from the beginning to discharge?

A 
ECG
Admit to CCU
Oxygen
IV access
Hx + exam
Antiplatelet- aspirin clopidogrel
Anticoagulate
Analgesia + antiemetics
GTN
Assess CDV risk: GRACE
19
Q

In which conditions are there raised troponin levels?

A

STEMI, NSTEMI, myocarditis, PE, intense exercise

20
Q

What are the different types of MI?

A

Type 1,2, 3, 4a, 4b, 5

21
Q

What is type 1?

A

CORONARY ARTERY ASSOCIATED- spontaneous MI due to primary coronary event (coronary artery plaque rupture and formation of thrombus)

22
Q

Type 2?

A

increaed oxygen demand or decreased oxygen supply- HF, sepsis, anaemia, hypertension
congestive HF, tachyarrhythmias, PE, sepsis, apical ballooning syndrome, anything that stresses the heart

23
Q

ST elevation is observed in inferior leads. Which coronary artery is affected?

24
Q

How can you determine post MI on ECG?

A

anterior lead is directly opposite and will see the opposite of any current generated at post wall i.e. post ST elevation=ant ST depression

25
Q

Following a successful PCI, what is the subsequent secondary prevention management?

A

ACE inhibitors, beta blockers, STATINS, cardiac rehab

26
Q

Which antiplatelet therapy is recommended for NSTEMI?

A

dual anti-platelet therapy= aspirin and P2Y12 inhibitor=ticagrelor

27
Q

Why would you do a FBC for suspected ACS?

A

to rule out type 2 cause of MI e.g. hypofusion caused by anaemia, sepsis, internal bleeding etc

28
Q

Why would you carry out CXR for suspected ACS?

A

to rule out HF and pulmonary origin of chest pain

29
Q

Explain the concept of silent MI

A

Diabetes patients do not experience typical chest pain during acute coronary syndrome

30
Q

What is the treatment for acute NSTEMI?

A

BATMAN- beta blockers, aspirin, ticagrelor, morphine, anticoagulant, nitrates

31
Q

What is Dressler’s syndrome?

A

post-myocardial infarction syndrome- localised immune response causing pericarditis

Cardiology (14 decks)

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