Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

CARDIO > old ACS > Flashcards

old ACS Flashcards

1
Q

what is the definition of ACS and what are the categories?

A

unstable angina + evolving MI

STEMI or new onset LBBB
NSTEMI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

what is the pathophysiology of ACS?

A

plaque rupture
thrombosis
inflammation
rarely due to coronary spasm, emboli or vasculitis in normal coronary arteries

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

what is the progression of ischaemic necrosis and ST elevation?

A

first subendocardial necrosis (non ST elevation MI- which showed ST depression + t wave inversion like agina)

then transmural necrosis (ST elevation MI- which shows ST elevation + t wave inversion + pathological q waves)

endocardium is spared due to o2/nutrients of ventricular blood

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

what vessels are most commonly obstructed?

A

50% LAD
30% RCA
20% LCx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

what are the modifiable risk factors for ACS?

A 
HTN
DM
smoking
high cholesterol
obesity
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

what are the non-modifiable risk factors for ACS?

A

age
male
FH M<55yo F<65yo

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

what can a silent MI present as?

A

syncope
delirium
post-op oliguria/hypotension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

who might have a silent MI?

A

diabetes
post cardiac surgery
elderly

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

what are the differentials for severe chest pain?

A 
angina
peri/endo/myocarditis
dissection, Takotsubo cardiomyopathy 
PE, pnuemothorax, pneumonia
costochondritis
GI- GORD, spasm, pancreatitis
anxiety
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

what are the ECG signs for STEMI (in sequence)

A 
normal
ST elevation and tall T waves
q waves- full thickness infarct
normalisation of ST segments
T wave inversion

new onset LBBB also STEMI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what are the ECG signs for NSTEMI?

A

ST depression
T wave inversion

no q waves= subendocardial infarct

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

what are the leads and vessels for inferior part of heart?

A

II III aVF

RCA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

what are the leads and vessels for anterolateral part of heart?

A

I aVL V4 V5 V6

LCx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

what are the leads and vessels for anteroseptal part of heart?

A

V2 V3 V4

LAD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

what are the leads and vessels for anterior part of heart

A

V2-V6

LMS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

what are the leads and vessels for posterior part of heart?

A

V1 V2 V3 (recipe)

RCA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

what are the complications of an inferior infarct?

A

bradyarrythmias

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

what are the complications of an anterior infarct?

A

LVF

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

what indicates a STEMI/LBBB diagnosis?

A

typical symptoms + ST elevation/LBBB

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

what indicates an NSTEMI diagnosis?

A

typical symptoms
no ST elevation
positive troponin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

what indicates unstable angina diagnosis?

A

typical symptoms
no ST elevation
negative troponin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

what is the prognosis of STEMI?

A

30 day mortality about 15%

varies with patient factors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

what is the prognosis of an NSTEMI?

A

overall mortality 1-2%

varies with patient factors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

what is the typical presentaiton of an MI?

A

severe chest pain >20 mins
sweating (increased sympathetic drive)
nausea
pallor
cold/clammy/thready pulse/peripherally shut down (hypotension)
dyspnoea/tachypnoea/increased JVP (pulmonary congestion)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
what are the atypical presentations of an MI?
pain only in jaw/arm or left shoulder etc only autonomic symptoms- sweating/vomiting feeling unwell arrythmia cardiac arrest heart failure
26
what can you find on examination in ACS?
``` nicotine staining/rothman's sign xanthelasma, pallor/anaemia carotid bruit, high/low bp/HR apex beat, murmurs AAA, femoral bruit glycosuria, foot pulses ```
27
what factors suggest high-risk ACS?
continuing chest pain troponin >10x normal impaired LV function heart failure abnormal ECG- previous MI, st dep/inversion, during low level exercise test extensive risk factors: diabetes, combination of smoking + HTN + high chol
28
what is the management of STEMI?
``` MONA B Morphine (analgesia + vasodilation) oxygen nitrate anticoagulant- aspirin/ticagrelor beta blockers PCI or thrombolysis- SK or tPA +/- CABG (within 4 hours) ```
29
on discharge, what medications should be started for someone who had a STEMI?
Ace inhibitor beta blocker- or CCB Statin
30
what are the contraindications for thrombolysis?
history of CVA stroke <3 months aortic dissection active bleeding
31
what does nitrates (GTN, isosorbide mononitrate) act as anti-anginal therapy?
coronary vasodilation which increases cardiac perfusion
32
what does beta blockers (propanolol/metoprolol) do in management of ACS?
decreases heart rate + contractility whihc decreases cardiac workload
33
what do calcium channel blockers (nifedipine/verapamil) do in management of ACS?
decreases afterload which decreases cardiac workload
34
what is the management of NSTEMI/UA?
``` aspirin morphine beta blocker s/c LMW heparin clopidogrel angiography in high risk cases +/- PCI/CABG ```
35
what are the symptoms of ACS?
``` acute central/left chest pain >20min radiates to left jaw/arm nausea, sweating dyspnoea palpitations ```
36
what are the signs of ACS?
anxiety pallor/sweating pulse high or low bp high or low 4th heart sound signs of LVF- basal creps, elevated jvp, 3RD HS PSM- papillary muscle dysfunction/rupture, VSD later- pericardial friction rub or peripheral oedema
37
what investigations for ACS?
bloods- FBC, UE, glucose, lipids, clotting, cardiac enzymes serial troponin- on presentation, 6 hours, within 24hours imaging- serial resting ECGs, CXR, ECHO 3-lead cardiac telemetry screening for arrythmias
38
what can be found on CXR for ACS?
cardiomegaly pulmonary oedema widened mediastinum- aortic rupture
39
what can be found on ECHO for ACS?
regional wall abnormalities
40
when is troponin elevated and when does it peak
elevated from 3-12h, need 12h trop to exclude MI peak 24h baseline from 5-14 days
41
for management of ACS, how would you modify their risk factors?
smoking cessation treat DM, HTN, hyperlipidaemia diet- oily fish, fruit, veg, fibre, low saturated fats daily exercise- cardiac rehab programme referral mental health- dep and anx associataed with poor cvs outcomes
42
how do you optimise cardioprotective medications for ACS patients?
1) antiplatelets: aspirin 75mg OD + 2nd antiplatelet eg ticagrelor/clopidogrel for at least 12 months. add PPI eg lansoprazole 2) anticoagulant until discharge eg fondaparinux 3) beta blocker reduces myocardial O2 demand. monitor pulse/BP. CI- use verapamil or diltiazem. 4) ACE-i in LVF, HTN, DM. CI- ARB. monitor renal fx. 5) high-dose statin eg atorvastatin 80mg 6) ECHO to assess LVF. eplerenone improves outcomes for MI with HF.
43
what general advice would you give regarding work and driving for ACS?
work- discuss with employer + change duties. functional testing if drivers of public service or heavy goods vehicles. cannot restart post-MI if airline pilot or air traffic controllers driving- group 1 licence (car/motorbike) after 1 week of successful angioplasty or 4 weeks after ACS unsuccessful angio. if EF>40% group 2 inform DVLA and stop driving. restart after 6 weeks after functional test results.
44
what is the management of a STEMI?
1) 12 lead ECG 2) O2 2-4L 94-98 3) IV access- bloods FBC, UE, glucose, lipids, cardiac enzymes 4) assess- hx, risk fc, thrombolysis CI, CV exam 5) antiplatelet- aspirin 300mg PO, clopidogrel 300mg PO 6) analgesia- morphine 5-10mg IV, metoclopramide 10mg IV 7) anti-ischaemia- GTN 2 puffs or 1 tablet SL, beta blcoker atenolol 5mg IV (CI- asthma, LVF) 8) LMWH - enoxaparin IV then SC 9) admit to CCU for monitoring- arryhtmias, continue meds except CCB 10) primary PCI or thrombolysis
45
what is PCI and when would you do it with STEMIs?
angioplasty + stenting + GP IIB/IIIA antagonist (tirofiban) if high risk (delayed PCI, DM, complex procedure) treatment of choice if <12h
46
what is PCI and what is the criteria for use with STEMIs?
angioplasty + stenting + GP IIB/IIIA antagonist (tirofiban) if high risk (delayed PCI, DM, complex procedure) treatment of choice if <12h
47
what are the complications of PCI?
bleeding emboli arrythmias
48
what is thrombolysis and what is the criteria for use in STEMI?
agents- 1st: streptokinase, alteplase (rt-PA), tenecteplase ``` ECG criteria: 1) ST elevation >1mm in 2+ limbs or >2mm in 2+ chest leads 2) new LBBB 3) posterior: deep ST depression and tall R waves in V1-V3 ```
49
what are the contraindications to thrombolysis in STEMI?
``` CI beyond 24hrs from pain onset AGAINST aortic dissection GI bleeding allergic reaction before iatrogenic- recent surgery neuro- cerebral neoplasm or CVA history severe HTN 200/120 trauma in CPR ```
50
what are the complications of thrombolysis?
bleeding stroke arrythmia allergic reaction
51
what is the continuing hterapy for STEMIs?
1) ACEi- start within 24hrs eg lisinopril 2.5mg 2) bb bisoprolol 10mg OD or CCB 3) cardiac rehab 4) DVT prophylaxis until fully mobile- continue for 3 months if large anterior MI 5) statin - ator 80mg 6) continue clopidogrel for 1 month, aspirin forever
52
continuing therapy general advice for STEMI?
``` stop smoking diet- oily fish, fruit, veg, low sat fats exercise- 30 min OD work- return in 2 months sex- avoid for 1 month driving- avoid for 1 month ```
53
what is the management of NSTEMI/UA?
1) 12 lead ECG + admit to CCU 2) O2- 2-4L 94-98 3) IV access- bloods FBC UE glucose lipids troponin 4) assess- hx and exam 5) antiplatelet- aspirin 300mg pO, clop 300mg PO 6) anticoagulant- fondaparinux 2.5mg SC 7) analgesia- morphine 5-10mg IV, metoclopramide 10mg IV 8) anti-ischaemia- GTN 2 puffs or 1 tablet SL, bb atenolol 50mg/24h PO. IV GTN if pain continues 9) assess CVD risk- GRACE/TIMI
54
what is the management of NSTEMI/UA if intermediate-high risk on GRACE/TIMI?
tirofiban- gpiib/iiia antagonist angiography +/- PCI within 96h clopidogrel 75mg/d for 1 year
55
what is intermediate-high risk for NSTEMI/UA on GRACE/TIMI?
persistent/recurrent ischaemia ST depression DM positive troponin
56
what is low risk for NSTEMI/UA on GRACE/TIMI?
no further pain flat or inverted T waves normal ECG negative troponin
57
what is the management of low risk NSTEMI/UA on GRACE/TIMI?
discharge fi 12h trop is negative | outpatient tests: angio, perfusion scan, stress echo
58
what is the continuing therapy for NSTEMI/UA?
1) ACE-i eg lisinopril 2.5mg 2) bb bisoprolol 10mg OD or CCB 3) cardiac rehab 4) stop antithrombotic therapy when pain free (but give 3-5 days) 5) statin 6) continue clop for 1 year following NSTEMI, aspirin forever
59
what is the pathophysiology of angina pectoris?
insufficient coronary perfusion relative to myocardial demand (decreased myocardial perfusion)
60
what are the causes of angina?
``` mostly ahteroma- atherosclerosis leading to myocardial ischaemia >70% occlusion anaemia aortic stenosis vasospasm embolism ascending aortic dissection exacerbated by- ventricular hypertrophy, tacycardia, hypoxia, coronary arteritis eg in SLE ```
61
what are the symptoms of angina?
central chest tightness/heaviness exertion, relieved by rest radiate to one/both arms/neck/jaw/teeth precipitants: emotion, cold weather, heavy meals
62
what is decubitus angina?
induced by lying down
63
what is prinzmetals/variant angina?
occurs during rest due to coronary spasm ST elevation during attack, resolves as pain subsides treat wiht CCB + long-acting nitrates
64
what is syndrome X angina?
angina pain + st elevation on exercise test but no evidence of conrary atherosclerosis may represent small vessel disease
65
what is unstable angina?
pre-infarction angian due to unstable atherosclerotic plaque +/- plaque disruption and thormbus prolonged angina at rest- either new, increased severity, increased frequency red flag- MI may be imminent
66
what are the differentials of angina/chest pain?
AS aortic aneurysm GI- GORD, spasm MSK
67
what are the investigations for angina?
``` bloods- FBC, UE, lipids, glucose, ESR, TFTs ECG, consider exercise ECG stress echo perfusion scan CT coronary ca2+ score angiography- gold standard ```
68
what is the gold standard investigation for angina?
angiography
69
what can be the ECG findings for angina?
usually normal st depression or flat/inverted t waves during attack, should be normal between attacks past MI
70
what is the lifestyle management of angina?
smoking cessation weight loss and more exercise healthy diet- oily fish, fruit, veg, low sat fats
71
what are the investigations for angina?
1st line- resting ECG 2nd line- cardiac stress test + ECG- suggests severity of CAD- any ST depression is positive result 3rd line- stress ECHO- assess ventricular function 4th line- coronary angiography 5th line- myocardial perfusion scans
72
what are the 2 categories of medical management of angina?
secondary prevention- prevent cardiovascular events . anti-anginals- prevents angina episodes
73
what is the secondary prevention (medical management) of angina?
aspirin 75mg OD ACE-i (esp if angina and DM) statins- simvastatin 40mg anti-HTN
74
what is the anti-anginal management of angina?
statin + aspirin 1) GTN (spray or SL) and either 1st- bb eg atenolol 50-100mg OD 2nd- CCB eg verapamil 80mg TDS 2) try 1st or 2nd if symptoms not controlled 3) try bb + dihydropyridine CCB eg amlodipine MR 10mg/24h 4) still not controlled: ISMN 20-40mg BD (8h washout at pm) OR slow release nitrate (imdur 60mg OD) ivabradine nicorandil 10-30mg BD ranolazine
75
what is the indication of PCI for angina?
poor response to medical treatment | refractory angina but not suitable for CABG
76
what are the complications of PCI for angina?
re-stenosis at 6 months emergency CABG MI death
77
how do you prevent re-stonisos complication of PCI for angina?
clopidogrel 1 month for bare metal stent 1 year for drug-elutin eg sirolimus
78
what are the indications of CABG for angina?
L main stem disease triple vessel disease refractory angina unsuccessful angioplasty
79
what are the complications of CABG for angina?
``` MI stroke pericardial tamponade or haemothorax postperfusion syndrome post-op AF nonunion of sternum graft stenosis ```
80
what can cause trop elevation apart from ACS?
``` chronic or acute renal dysfunction HTN crisis tachy or bradyarrythmias PE myocarditis (inflam disease) stroke severe congestive HF- acute and chronic ``` hypothyrodism drug toxicity- adriamycin, 5FU herceptin, snake venoms rhabodmyolysis resp failure/sepsis
81
what are acute complications of an MI?
LV failure- acute pulmonary oedema, shock (70% mortality) lethal arrythmias- VT, VF weakening of necrotic myocardium leads to myocardial rupture -> tamponade/acute VSD stasis leads to mural thrombosis -> embolisation -> stroke
82
what are the chronic complications of an MI?
ventricular aneurysm papillary muscle rupture mitral regurgitation, CCF
83
what are the groups of MI complications
death- by VF, LVF, CVA pump failure pericarditis rupture- myomalacia cordis arrythmias bradycardias ventricular aneurysms embolism dressler's syndrome- pleuro-pericarditis
84
in terms of MI complications, how can pericarditis present?
occurs early mild fever central chest pain/change in pain relieved by sitting forward pericardial friction rub
85
what are the ECG changes in pericarditis?
saddle-shaped ST elevation +/- PR depression
86
what is the treatment of pericarditis?
NSAIDs ECHO to exclude effusion
87
in terms of MI complications, what can rupture of left ventricular free wall rupture cause?
cardiac tamponade - beck's triad (low bp, raised jvp, muffled heart sounds), pulsus paradoxus
88
what can rupture of papillary muscles/chorae tendinae cause?
mitral regurgitation- pansystolic murmur, pulmonary oedema
89
in terms of MI complications, how can ventricular aneurysms present?
4-6 weeks LVF angina recurrent VT systemic emboli ECG- persistent ST elevation
90
how does an embolism occur in MI complications?
arise from LV mural thrombus consider warfarin 3 months after large anterior MI
91
how can dressler's syndrome present?
due to auto antibodies vs myocyte sarcolemma 2-6 weeks recurrent pericarditis pleural effusions fever anaemia raised ESR treat- NSAIDs, if severe- steroids
92
what is the result of MI complications- give 3
decreased contractility electrical instability tissue necrosis
93
after an MI what does decreased contractility cause?
hypotension - decreased coronary vessel perfusion - ischaemia - further decreased contractility THEREFORE cardiogenic shock blood stasis - ventricular thrombus - emboli- stroke
94
after an MI how does electrical instability occur and what happens?
disorganisation in ion movement in myocyte compromised internal conduction system (SA/AV node) esp if Right Atrium effected THEREFORE arrythmias
95
after an MI what does tissue necrosis cause?
leads to inflammation of surrounding tissue- pericarditis if effects septum- breaks down - VSD (hypoxaemia as L to R shunt) if effects ventricles- ventricle rupture - blood builds up within pericardium- cardiac tamponade if effects papillary muscles + chordae tendinae - prolapse - mitral regurgitation
96
what are the immediate/hours STEMI complications?
ventricular arrythmias- VT/VF atrial arrhythmias- AF failed reperfusion
97
what are the STEMI complications at hours-days?
``` cardiac rupture re-infarction heart failure cardioenic shock severe impairment of LVF RV infarction mechanical catastrophe - ventricular septal rupture, papillary muscle rupture ```
98
what are the STEMI complications days-weeks?
thromboembolism- CVA chronic HF ventricular tachycardia implies myocardial scar dressler's syndrome- autoimmune pericarditis after full thickness MI
99
what is the progression of ischaemic necrosis and ST elevation?
first subendocardial necrosis (non ST elevation MI- which showed ST depression + t wave inversion like agina) then transmural necrosis (ST elevation MI- which shows ST elevation + t wave inversion + pathological q waves) endocardium is spared due to o2/nutrients of ventricular blood

CARDIO (10 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions