Lecture 22- Investigatuon Of Acute Corniary Syndrome

Question 1

What causes acute coronary syndromes?

Answer 1

Generally coronary occlusion but not always

Question 2

Universal definition of MI?

Answer 2

Elevated troponin and one of symptoms of ischaemia,Q waves, ST elevation, intracoronary thrombus, imaging evidence of loss of viable myocardium

Question 3

MI classification?

Answer 3

Type 1 due to plaque rupture leading to reduced blood flow

Type 2 condition other than plaque instability like anaemia, hypotension etc

Question 4

How to investigate ACS?

Answer 4

What happened 
When it happened 
Why it happened 
How bad is it 
Where it happened 

Go to slides for answers detailed

Question 5

Q waves on ECG?

Answer 5

Mean muscle is already dead

Question 6

ECG?

Answer 6

ST elevation indicates sudden occlusion

ST depression implies under supply of blood to myocardium

T wave inversion often implies under supply of blood but can be cardiomyopathy also

ECG grace follows shape of heart. ST elevations in anteroseptal leads follow left anterior descending coronary artery

Question 7

Which coronary artery supplies largest part of heart?

Answer 7

Left anterior descending

Question 8

Why are bloods important in treatment?

Answer 8

Determine platelet count for anti platelet drugs. Kidney function as some drugs can damage kidney etc

Question 9

Troponin elevation?

Answer 9

Raised within 3 hours. Peaks from 24-48 and remains elevated for two weeks

Question 10

Chest X ray in acute coronary syndrome?

Answer 10

Fluffy lung means pulmonary oedema

Also check for cardiac size and for pleural effusion

Question 11

Echocardiogram?

Answer 11

Used to determine cause of ACS. Looks at valves, flow patterns etc

Question 12

Invasive coronary angiogram.

Answer 12

Performed after bloods, echocardiogram and chest x ray usually 48-72 hours after MI

Question 13

How can you treat an occluded coronary artery?

Answer 13

Using a stent to hold it open