Session 9- Acute Coronary syndrome

Question 1

which acute coronary syndromes will have myocardial damage

Answer 1

STEMI

NSTEMI

Question 2

what is a type 1 MI

Answer 2

artherosclerotic plaque rupture, ulceration, fissure, erosion or dissection with resulting intraluminal thrombus in one or more coronary arteries leading to decreased myocardial blood flow and or distal embolisation and subsequent myocardial necrosis

Question 3

what history would you take

Answer 3

cardiac sounding|?
radiation?
relieved with GTN?
How long
is it getting worse 
pleuritic

Question 4

risk factors

Answer 4

smoker
family history
high cholesterol
Hypertension
thrombiphilia

Question 5

what are the lateral terrotories

Answer 5

I
aVL
V5
V6

Question 6

what are the inferior leads

Answer 6

II
III
aVF

Question 7

what are the anteroseptal leads

Answer 7

V3
V4
V2
V1

Question 8

what are the septal leads

Answer 8

V1 AND V2

Question 9

Anterior leads

Answer 9

V1 -V6

Question 10

lateral leads

Answer 10

V5 AND V6

Question 11

anterolateral leads

Answer 11

V3 -V6

Question 12

high lateral chest leads

Answer 12

I

aVL

Question 13

what does ST elevation indicate

Answer 13

sudden occulsion

full thickness of myocardium has been affected

Question 14

what does ST depression indicate

Answer 14

implies under-supply of blood to myocardium but not sudden coronary occlusion. If in the anterior leads it can sometimes be due to sudden occulsion of a vessel at the back of the heart- Posterior STEMI

Question 15

what does T wave inversion imply

Answer 15

under-supply of blood to myocardium but not sudden coronary occlusion. There are other non-ischaemia related causes

Question 16

how does ST elevation evolve

Answer 16

hyperacute T waves
ST segment elevation
T wave inversion
pathological Q waves

Question 17

management of STEMI

Answer 17

• aspirin
• ticagrelor
• morphine IV with metaclopramide
• nitrate 2 puffs under tongue
• oxygen
• Time is muscle
• direct transfer to cardiac catheter labs for PCI

Question 18

management of NSTEMI

Answer 18

antiplatelets and antithrombotic
anti-ischaemics
secondary prevention

Question 19

what is the difference between stable and unstable angina

Answer 19

Stable angina is when you get angina symptoms during moderate physical activity or when you are pushing yourself physically. These symptoms go away with rest and/or medication. Unstable angina is when you get angina symptoms while doing very little or resting.

Question 20

invasive coronary angiogram

Answer 20

establises type of lesion and location

local anesthetic

radial or femoral artery access

30 min process

wire occluced vessel

predilatate the narrowed section with balloons

stent with metal scaffold to keep vessel patent

option to include intravascular ultrasound or optical coherence tomography

Question 21

ECG progression of a STEMI

Answer 21

1) hyperacute T waves
2) ST elevation
3) T wave inversion
4) Pathological Q waves