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PHAM01 > Wk 12: Acute coronary syndrome > Flashcards

Wk 12: Acute coronary syndrome Flashcards

1
Q

What is acute coronary syndromes?

A
  • Unstable angina
  • MI
  • Due to plaque rupture, thrombosis + inflammation in coronary artery
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2
Q

What is the presentation of unstable angina?

A

NSTEMI w/o significant rise in cardiac troponin

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3
Q

What are the non-modifiable risk factors of ACS?

A
  • Age
  • Male
  • Fam history
  • Ethnicity
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4
Q

What are the modifiable risk factors of ACS?

A
  • Smoking
  • Diabetes
  • Hypertension
  • Dyslipidemia
  • Obesity
  • Lack of exercise
  • Cocaine use
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5
Q

What are the symptoms of ACS?

A
  • Acute chest discomfort >15mins or past 12 hrs
  • Dull, central and/or crushing
  • Not relieved by rest
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6
Q

What are the associated symptoms of ACS?

A
  • Anxiety
  • Nausea
  • Pallor sweating
  • Palpitations
  • Dyspnoea
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7
Q

What are the signs of ACS?

A

Haemodynamic instability (systolic <90)

  • Tachycardia + sweating: sympathetic
  • Bradycardia, nausea + vomiting: vagal
  • 4th heart sound, low grade fever
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8
Q

What are the signs of heart failure?

A
  • 3rd heart sound
  • Inc JVP
  • Basal crepitations
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9
Q

What are the non-cardiac causes of chest pain?

A
  • Respiratory: PE, pneumothorax, CAP
  • Other: acute pancreatitis, GORD, spinal disorder, cancer
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10
Q

What is the initial management of suspected ACS?

A
  • 999
  • Aspirin 300mg STAT
  • Pain relief: GTN or IV diamorphine 2.5-5mg over 5 mins
  • 12 lead ECG
  • Oxygen: if hypoxic
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11
Q

How do you diagnose ACS?

A
  • Cardiac HX
  • CV examination
  • 12 lead ECG
  • Blood sample: High sensitivity troponin I or T
  • BP, HR + O2 stats
  • Chest x-ray
  • FBC, U+E, Lipid, LFT, HbA1c, CRP, ESR
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12
Q

What is PCI?

A
  • Angiography
  • Access via radial/femoral artery
  • X-ray guided insertion through aorta into affected coronary artery
  • Insertion of inflated balloon + stent to restore blood flow
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13
Q

What happens after assessing a patient with a STEMI?

A

Angiography or fibrolysis

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14
Q

What is the dual antiplatelet therapy for PCI in a STEMI?

A
  • Aspirin lifelong + P2Y12 inhibitor for 12 months (prasugrel)
  • Clopidogrel (high risk bleed or on anticoagulant)
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15
Q

What antithrombotics are offered alongside antiplatelet therapy for PCI?

A
  • Unfractionated hep w/ bailout glycoprotein IIb/IIa inhibitor
  • Bivalirudin if femoral access needed
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16
Q

What are fibrinolytics?

A

Activates plasminogen: forms plasmin, degrades fibrin + breaks up thrombin

17
Q

Give some examples of fibrinolytics

A
  • Streptokinase
  • Alteplase
  • Tenecteplase
18
Q

What is the medical management of STEMI?

A

Aspirin + ticagrelor (clopidogrel if high bleed risk)

19
Q

What is the initial antithrombin therapy of NSTEMI/unstable angina?

A

Fondaparinux

20
Q

How does fondaparinux work?

A
  • Binds antithrombin III
  • Neutralizing factor Xa
  • Interrupts clotting cascade
21
Q

What would you consider for NSTEMI/unstable angina within 72 hrs?

A
  • Angiography + PCI
  • PCI eligible: give unfractionated heparin
22
Q

What are the dual antiplatelet therapy for an NSTEMI/unstable angina?

A

Aspirin +

  • Prasugrel (if PCI)
  • Ticagrelor (No PCI) or clopidogrel (high bleed risk/anticoagulant
23
Q

What are the assessments post MI?

A
  • Left ventricular function assessment
  • Bleeding risk
24
Q

What are the drugs used for secondary prevention?

A
  • ACE (ARB)
  • Beta blocker
  • DAPT
  • Statin
  • Aldosterone antagonist
25
Q

When are ace inhibitors started?

A
  • Hemodynamically stable
  • Titrate up every 12-24 hrs, complete w/in 6 wks
  • Monitor: renal, U+E, BP before starting + every 2-4 wks
26
Q

When are beta blockers started?

A
  • Hemodynamically stable
  • Titrate slowly
  • Monitor HR + BO
  • 12 months all patients, lifelong if HF w/ red LVEF
27
Q

Which statin is used?

A

Atorvastatin 80 mg

28
Q

What needs monitoring when on a statin?

A
  • TFT + HbA1c before starting
  • Liver enzymes, cholesterol + HbA1c at 3 months then annually
  • CK if persistent muscle pain
29
Q

When are aldosterone antagonists used?

A
  • HF w/ red LVEF
  • Initiate after ACE + w/in 14 days of MI
  • Monitor: renal function + U+Es
30
Q

What are the counselling points for ACS?

A
  • Mediterranean diet: bread, fruit, veg + fish
  • Alcohol max 14 u/wk
  • 20-30 mins exercise a day to slight SOB
  • Smoking cessation
  • Healthy BMI
  • Annual flu vaccine

PHAM01 (47 decks)

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