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CR2 > ACS and STEMI > Flashcards

ACS and STEMI Flashcards

1
Q

Acute coronary syndrome

A

Any condition where blood supplied to heart muscle reduced

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2
Q

What is an NSTEMI

A

Non ST elevation myocardial infarction

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3
Q

What is a STEMI

A

ST elevation myocardial infarction

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4
Q

Are STEMIs or NSTEMIs more prevalent

A

NSTEMIs

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5
Q

2 types of NSTEAC

A

NSTEMI
unstable angina

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6
Q

How to tell between NSTEMI and unstable angina

A

troponin positive in NSTEMI
Troponin negative in unstable angina

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7
Q

STEMI characteristics

A

Persistent Acute chest pain 20min+
ST segment elevation

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8
Q

What usually causes a STEMI

A

Acute total coronary occlusion

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9
Q

NSTEMI ECG characteristics

A

No persistent ST elevation
Persistent or transient ST depression
Persistent or transient T wave inversion

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10
Q

Is troponin elevated in STEMI

A

Yes

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11
Q

When should ECG be taken in suspected ACS

A

First - before history and examination

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12
Q

What should be done if initial ECG normal in suspected ACS

A

Repeat/serial ECGs

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13
Q

What are the 3 criteria needed for acute myocardial infarction

A

Acute myocardial injury - elevated troponin
Rise/fall of cTn values w at least 1 value above 99th percentile
Clinical evidence of acute myocardial ischaemia with at least 1 of - myocardial ischaemia symptoms, new ischaemic ECG changes, pathological Q waves, new loss of viable myocardium or new regional wall motion abnormality in pattern consistent w ischaemic aetiology, coronary thrombus

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14
Q

3 types of ACS

A

STEMI
NSTEMI
Unstable angina

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15
Q

ACS signs and symptoms

A

Chest pain >15 mins
Pain in other areas
Nausea
Vomiting
Sweating
Breathlessness
Haemodynamic instability
Abrupt deterioration in stable angina

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16
Q

ACS risk factors

A

Hypertension
Smoking
High lipid signs

17
Q

What are xanthelasma and arcus lipids signs of

A

High lipids

18
Q

How can acute chest pain be investigated

A

Blood test
Chest x ray
Resting ECG
Coronary CT
Stress echo
Stress MRI
Myocardial perfusion scan
Coronary angiogram

19
Q

what does ABCDE stand for in ACS management

A

Airways and oxygen
Breathing and ventilation
Circulation and shock management
Disability due to neurological deterioration
Exposure and examination

20
Q

What ACS treatment is needed while waiting for transfer

A

Anti platelet therapy
Analgesia

21
Q

Anti platelet therapies

A

Aspirin
Clopidogrel
Ticagrelor
Prasugrel

22
Q

Which Analgesics for ACS while waiting for transfer

A

Glyceryl trinatrate - GTN
Opioids

23
Q

Limitations of clopidogrel

A

Slow onset of action
Variable degree platelet inhibition
Variable clinical response
Drug interaction

24
Q

How often are clopidogrel, prasugrel, and ticagrelor administered

A

Clopidogrel - once daily
Prasugrel - once daily
Ticagrelor - twice daily

25
Q

How long does clopigrel, Prasugrel, and Ticagrelor have an effect for

A

C - 3-10 days
P - 7-10 days
T - 3-5 days

26
Q

What is the minimum amount of time clopidogrel, Prasugrel, and ticagrelor should be discontinued before surgery

A

C - 5 days
P - 7 days
T - 3 days

27
Q

When should oxygen be given to ACS patients

A

SaO2<90% or PaO2<60mmHg

28
Q

When are Q waves pathological

A

> 2mm deep or wide

29
Q

What is used for rate control in ACS

A

Short acting beta blockers

30
Q

What factors are involved in calculating grace score

A

Age
Heart rate
Systolic blood pressure
Creatinine
Congestive heart failure
Cardiac arrest at admission
ST segment deviation
Elevated cardiac enzymes/markers

31
Q

When should an immediate coronary angiography be offered

A

People with unstable angina or NSTEMI where clinical condition is unstable

32
Q

Wellens syndrome

A

abnormal electrocardiographic (ECG) pattern, deeply inverted T waves in leads V2 and V3, that are secondary to proximal LAD stenosis

33
Q

When should an urgent call be made to cardiology for immediate Cather termination consideration

A

Inability to eliminate chest pain using maximal medical therapy
Wellness syndrome
Dynamic ST Depression

CR2 (33 decks)

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