Investigationan And Management Of Patiens With Acute Coronary Syndrome Flashcards
What is an acute coronary syndrome?
When a coronary artery thickens and the atherosclerotic plaque ruptures releasing thrombogenic material leading to thrombus formation
If a patient does not have ST-segment elevation how can you tell they have had a myocardial infarction?
Retro sternal chest pain radiating the jaw and/or shoulder
Elevated troponin
Pathological Q waves
Intracoronary thrombus on angioplasty
What is a Type 1 Myocardial Infarction?
Atherosclerotic plaque ruptures which leads to an intraluminal thrombus forming leading to myocardial necrosis
What is a Type 2 Myocardial Infarction?
When an MI occurs as a result of something other than a coronary plaques instability
Due to supply and demand mismatch
If Jugular Vein Pressure is increased what may this indicate?
Right heart failure
What are the 3 main coronary arteries?
Right coronary artery
Left coronary artery:
2 branches
-Left Anterior Descending
-Circumflex
What does the right coronary artery supply?
Supplies SAN and AVN
RA + RV
If the right coronary artery gets occluded what happens to the the heart rate?
Reduces due to the right coronary artery supplying the SAN and AVN
If leads II, III and aVF are affected (ST elevation or depression) in an ECG what wall is this looking at of the heart?
What coronary artery is therefore affected?
Inferior wall
Right coronary artery
If leads V1, V2, V3 and V4 are affected (ST elevation or depression) in an ECG what wall is this looking at of the heart?
What coronary artery is therefore affected?
Anteroseptal
Left Anterior Descending artery
If leads I, aVL, V5 and V6 are affected (ST elevation or depression) in an ECG what wall is this looking at of the heart?
What coronary artery is therefore affected?
Lateral wall
Circumflex
What can be viewed in an ECG with a STEMII?
ST elevation
T wave inversion
Pathological Q waves
What isoforms of Troponin are measured and are specific to cardiac myocyte death?
Troponin I
Troponin T
What type of ultrasound is used to view the heart to assess coronary arteries?
Echocardiogram
What drugs are used in the management of a STEMI?
Aspirin (Antiplatelet)
Ticagrelor (Anticoagulant)
Morphine (Analgesic)
Metoclopramide (Antiemetic/anti vomit)
How can NSTEMI be managed?
Antiplatelet (Aspirin)
Anti-Ischaemic (Bisoprolol/Slows heart) Atenolol is just an older version of Bisoprolol, Bisoprolol is even more cardiac specific than Atenolol
Statins (Atorvastatin)
ACE inhibitors
What must happen if a patient has ongoing chest pain and dynamic ECG changes?
Urgent Percutaneous Coronary Intervention (PCI)
When doing a Percutaneous Coronary Intervention, what arteries does the balloon angioplasty pass through to reach the coronary artery?
Radial artery
Brachial artery
Axillary artery
Subclavian artery
Aorta then Coronary artery
What lifestyle changes could somebody do to reduce risk factors of acute coronary syndrome?
Low fat diet
Regular exercise
Low salt
Smoking cessation
What does Bisoprolol do?
Decrease HR
B1 adrenergic receptor antagonist
What area of the heart is being looked at by Leads II, III and aVF?
If there is ST elevation here what coronary artery is occluded?
Inferior wall
Right Coronary Artery
What area of the heart is being looked at by Lead V1, V2, V3 and V4?
If there is ST elevation here what coronary artery is occluded?
Anteroseptal and anteroapical
Left Anterior Descending (LAD)
What area of the heart is being looked at by Leads I, aVL, V5 and V6?
If there is ST elevation here what coronary artery is occluded?
Anterolateral
Circumflex artery
What area of the heart does V1 and V2 look at?
Anteroseptal
What area of the heart does V3 and V4 look at?
Anteroapical
