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CVS * > S9 Investigation and Management of ACS > Flashcards

S9 Investigation and Management of ACS Flashcards

1
Q

What is the most common acute coronary syndrome? What are two rarer pathologies?

A
  • atheromatous plaque rupture
  • coronary dissection
  • coronary spasm
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2
Q

What is a type 1 MI?

A
  • atherosclerotic plaque rupture/ulceration/fissure/erosion/dissection
  • results in thrombus in one or more coronary arteries
  • decreased myocardial blood flow and or distal embolisation
  • myocardial necrosis
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3
Q

What is critical information to get from a history when assessing a patient for MI/angina?

A
  • is there any radiation?
  • is the pain dull with central tightness?
  • is the pain relieved with GTN spray and how long does it take to have an affect?
  • is the pain getting worse?
  • is it pleuritic pain?
  • does the patient have any risk factors e.g. smoking, family history, hypertension, high cholesterol, thrombophilia?
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4
Q

What would you assess on examination of a patient with a possibility of acute chest syndrome?

A
  • BP (systolic pressure of below 90mmHg)
  • tachycardia or bradycardia (heart block?)
  • auscultation of the lungs - clear or wet?
  • any unusual heart sounds e.g. murmurs
  • does the patient have cool peripheries?
  • check the JVP
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5
Q

Which ECG leads look at the lateral aspect of heart?

A

Lead I, aVL, V5 and V6

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6
Q

What are the major coronary arteries?

A
  • right coronary artery

* left main coronary artery - circumflex artery and left anterior descending artery/interventricular anterior artery

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7
Q

Which ECG leads look at the inferior aspect of heart?

A

Leads II, III and aVF

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8
Q

Which ECG leads look at the anteroseptal aspect of heart?

A

V1, V2, V3, V4

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9
Q

If an infarct is in the septal aspect which leads will be abnormal?

A

V1 and V2

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10
Q

If an infarct is in the anterior aspect which leads will be abnormal?

A

V1 to V6

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11
Q

If an infarct is in the lateral aspect which leads will be abnormal?

A

V5 and V6

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12
Q

If an infarct is in the anteroseptal aspect which leads will be abnormal?

A

V1-V4

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13
Q

If an infarct is in the anterolateral aspect which leads will be abnormal?

A

V3-V6

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14
Q

If an infarct is in the inferior aspect which leads will be abnormal?

A

II, III and aVF

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15
Q

If an infarct is in the high lateral aspect which leads will be abnormal?

A

I and aVL

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16
Q

What does ST elevation imply?

A

Sudden occlusion

Long term it is a mark of left ventricular aneurysm

17
Q

What does ST depression imply?

A

Under supply of blood to the myocardium but no sudden coronary occlusion

If in anterior leads can be due to a sudden occlusion of a vessel at the back of the heart (posterior STEMI)

Non-ischaemic causes as well

18
Q

What does T wave inversion imply?

A

Under supply of blood to the myocardium but no sudden coronary occlusion

Can be a non-ischaemic cause

19
Q

What is the immediate response if a patient has ST elevation?

A

Patient straight to cath lab for emergency percutaneous coronary intervention (PCI)

20
Q

What does an ECG look like for someone with NSTEMI?

A
  • can be normal
    Or
  • T wave inversion
  • ST depression
21
Q

What blood tests do you do to determine if someone has NSTEMI?

A
  • Hb
  • test renal function
  • cholesterol
  • HBA1c
  • troponin
22
Q

What is troponin measured using?

A

Immunoassay

23
Q

How long do troponin levels stay raised for?

A

2 or more weeks

24
Q

What is the pathway for STEMI management?

A
  1. Give 300mg aspirin (antiplatelet drug)
  2. Ticagrelor 180mg/Prasugrel 60mg (second antiplatelet drug)
  3. Morphine 5-10mg IV with metoclopramide 10mg IV (for pain and nausea symptoms of morphine)
  4. Nitrate (GNT) 2 puffs under tongue (reduced BP)
  5. Oxygen if oxygen saturation below 92%
  6. Direct transfer to cardiac catheter labs for PCI
25
Q

What is the management for a NSTEMI?

A
  • antiplatelet and antithrombotic drugs - aspirin/clopidogrel and enoxaparin (LMWH)
  • anti-ischaemics - bisopolol/GTN infusion
  • secondary prevention - statin and ACE inhibitors
26
Q

If a patient has NSTEMI but has dynamic ECG changes or develops arrhythmia with compromise what should you do?

A

An urgent PCI

27
Q

Why do you do an invasive coronary angiogram?

A

To establish the type of lesion and its location

28
Q

Into which artery do you do an invasive coronary angiogram?

A

Radial or femoral artery

29
Q

How can you manage someone post MI/stent insertion?

A
  • lifestyle changes - low fat diet, regular exercise and low salt
  • dual antiplatelets for 12 months then aspirin for life
  • statins
  • bisoporol
  • ACE inhibitor

CVS * (17 decks)

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