CV Diseases

Question 1

What leads to acute coronary syndrome?

Answer 1

Plaque rupture/fibrous cap erosion are common causes.

Leads to reduced coronary blood flow and myocardial ischaemia

Question 2

STEMI, NSTEMI and unstable angina are all examples of what?

Answer 2

Acute coronary syndrome

Question 3

What are the symptoms of acute coronary syndrome?

Answer 3

New-onset chest pain and/or chest pain at rest
worsening angina
10/10 pain
Possibly pleuritic pain and breathlessness

Question 4

What investigations would you do for acute coronary syndrome?

Answer 4

ECG
Cardiac troponins
CK enzyme

Question 5

What would an ECG show in acute coronary syndrome?

Answer 5

ST depression, T wave inversion and/or Q waves

Question 6

How can you differentiate unstable angina from NSTEMI?

Answer 6

NSTEMI - enough ischaemia to cause myocardial damage - releasing detectable markers

Unstable angina - no elevated troponin, ST depression and T wave inversion

Question 7

What investigations would you do for a suspected NSTEMI and unstable angina

Answer 7

urgent angiography - to prevent progression to stemi

Exercise ECG

Question 8

What would cardiac troponins show in acute coronary syndrome?

Answer 8

Elevated - typically after 4 hrs

Could last up to 7 days

Question 9

Treatment for NSTEMI or unstable angina?

Answer 9

Low risk - aspirin, clopidogrel and nitrates
MONAC: diaMorphine, Oxygen, Nitrate, Aspirin, Clopidogrel

Revascularisation (PCI, thrombolysis) in high risk patients

Question 10

What are the investigations for a STEMI?

Answer 10

ECG must show ST elevation, T wave inversion, Q waves

Bloods - troponin levels, CK, electrolytes and lipids

Question 11

What is the treatment of a STEMI?

Answer 11

MONAC
diaMorphine IV + anti-emetic (metoclopramide)
O2 if hypoxic
glyceryl triNitrate sublingual
Aspirin chewed, clobidogrel 300mg oral gel

PCI within 90mins

thrombolysis if PCI unavailable