Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

cardiology > Acute Coronary Syndrome > Flashcards

Acute Coronary Syndrome Flashcards

1
Q

what is an acute coronary syndrome?

A

constellation of symptoms and clinical findings which results from impaired cardiac perfusion at rest

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

what are the sub-types of ACS?

A
  1. unstable angina
  2. non-ST elevation myocardial infarction
  3. ST-elevation myocardial infarction
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

what is the difference betwen MI and angina?

A

MIS is the underperfusion of the myocardium leading to death of myocardial tissue

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

what are the non-modifiable risk factors for ACS?

A
  • age
  • male sex
  • family history
  • ethnicity (particularly South Asians)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

what are the modifiable risk factors?

A
  • smoking
  • hypertension
  • hyperlipidaemia
  • hypercholesterolaemia
  • obesity
  • diabetes
  • stress
  • high fat diets
  • physical inactivity
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

what is a STEMI?

A

complete occulsion of a coronary artery

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

what is an NSTEMI?

A

severe by incomplete stenosis/occlusion of a coronary artery

some patients can have NSTEMIs due to lack of cardiac oxygenation for other reasons (e.g. severe sepsis, hypotension, hypovolaemia, coronary artery spasm)

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

describe the chest pain typically experienced in ACS

in terms of SOCRATES

A
  • site - central/left sided
  • onset - sudden
  • character - crushing (‘like somene is sitting on your chest’)
  • radiation - left arm, neck and jaw
  • associated symptoms - nausea, sweating, clamminess, shortness of breath, sometimes vomiting or syncope
  • timing - constant
  • exacerbating/relieving factors - worsened by exercise/exertion and may be improved by GTN
  • severity - extremely severe
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

name some atypical presentations of ACS

A
  • epigastric pain
  • acute breathlessness
  • palpitations
  • acute confusion
  • diabetic hyperglycaemic crises
  • syncope
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

what patients are more likely to experience ACS without pain?

A

elderly and patients with diabetes

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

what are the diagnostic features of unstable angina?

A
  • cardiac chest pain
  • abnormal/normal ECG
  • normal troponin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

what are the diagnostic features of NSTEMI?

A
  • cardiac chest pain
  • abnormal/normal ECG (not ST-elevation)
  • raised troponin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what are the diagnostic features of STEMI?

A
  • cardiac chest pain
  • persistent ST-elevation/new LBBB

no need for a tropnin in this case

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

what are the ECG requirements for a diagnosis of STEMI?

A
  • ST segment elevation 2mm in adjacent chest leads
  • ST segment elevation 1mm in adjacent limb leads
  • new LBBB with chest pain or suspicion of MI
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

what investigations should be undertaken in ACS?

A
  • ECG
  • troponin - at least 3 hours after pain starts and then repeated at 6-12 hours
  • renal function
  • blood glucose
  • lipid profile
  • FBC and CRP
  • chest x-ray
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

what region and coronary artery is affected when there is ST elevation in II, III and aVF?

A
  • inferior
  • right coronary artery (RCA)
15
Q

what region and coronary artery is affected when there is ST elevation in V1-2?

A
  • septal
  • proximal left anterior descending
16
Q

what region and coronary artery is affected when there is ST elevation in V3-4?

A
  • anterior
  • left anterior descending
17
Q

what region and coronary artery is affected when there is ST elevation in V5-6?

A
  • apex
  • distal left anterior descending/right coronary artery
18
Q

what region and coronary artery is affected when there is ST elevation in I and aVL?

A
  • lateral
  • left circumflex
19
Q

what region and coronary artery is affected when there is ST elevation in V7-V9 (ST depression V1-3)?

A
  • posterolateral
  • right coronary artery/left circumflex
20
Q

what are some non-ACS causes of a raised troponin?

A
  • MI
  • pericarditis
  • myocarditis
  • arrythmias
  • defibrillation
  • acute heart failure
  • pulmonary embolus
  • type A aortic dissection
  • chronic kidney disease
  • prolonged strenuous exercise
  • sepsis
21
Q

what is the acute managemnet of a STEMI?

A
  1. targeted oxygen therapy (aiming for stats >90%)
  2. loading dose of PO aspirin 300mg
  3. sublingual GTN spray
  4. IV morphine/diamorphine
  5. PCI
22
Q

what are the criteria for PCI?

A
  • present within 12 hours of onset of pain AND
  • are **<2 hours **since first medical contact
23
Q

what is the acute management of an NSTEMI?

A
  1. targeted oxygen therapy (aiming for stats >90%)
  2. loading dose of PO aspirin 300mg and fondaparinux
  3. sublingual GTN spray
  4. IV morphine/diamorphine
  5. antithrombin therapy - LMWH
  6. high 6 month risk of mortality = angiogram within 96 hours of symptom onset
24
Q

what is the post-MI management?

A
  1. aspirin 75mg OM + second antiplatelet (clopidogrel 75mg OD or ticagrelor 90mg OD)
  2. beta blocker (bisoprolol)
  3. ACE inhibitor high dose statin (ramipril)
  4. high dose statin (atorvastatin)

ECHO + cardiac rehabilitation

25
Q

what are the complications of an MI?

A
  • ventricular arrhythmia
  • recurrent ischaemia/infarction/angina
  • acute mitral regurgitation
  • congestive heart failure
  • 2nd, 3rd degree heart block
  • cardiogenic shock
  • cardiac tamponade
  • ventricular septal defects
  • left ventricular thrombus/aneurysm
  • left/right ventricular free wall rupture
  • dressler’s syndrome
  • acute pericarditis
26
Q

what are ventricular arrhythmias?

in the context of post-MI

A
  • can occur as a consequenc eof MI, during cardiac catheterisation or after reperfusion
  • short-lived and self-resolve
  • if sustained VT or VF -> ALS
27
Q

what is recurrent ischaemia/infarction/angina?

in the context of post-MI

A
  • occasionally inserted stents can thrombose requring reintervention
  • new infarcts can occur in different vascular territories
  • angina and chest pain can continue for some time after an MI
28
Q

what is congestive heart failure?

in the context of post-MI

A
  • heart failure can occur as a consequence of impairment heart muscle function secondary to ischaemia
  • treated as any other acute heart failure
  • ventricular function may improve over months as the heart muscle recovers
29
Q

what is heart block?

in the context of post-MI

A

common following inferior infarcts
management =
* simple observation
* transcutaneous/venous pacing
* permanent pacing

30
Q

what is left ventricular thrombus/aneurysm?

in the context of post-MI

A
  • occur following an anterior MI
  • definitely diagnosed on ECHO
31
Q

what is acute mitral regurgitation?

in the context of post-MI

A
  • occur because of papillary muscle rupture
  • pansystolic murmur best heard at the apex
  • severe and sudden heart failure
32
Q

what is ventricular septal defect?

in the context of post-MI?

A
  • short-term complication
  • rupture caused by anterior = apical and simple
  • rupture caused by inferior = basal and complex
  • occurs within the 1st week afer the infarction
33
Q

what are the features of ventricular septal rupture?

A
  • shortness of breath
  • chest pain
  • heart failure
  • hypotension
  • harsh, loud pan-systolic murmur
  • palpable parasternal thrill
34
Q

what is dressler’s syndrome?

A
  • post-infarction pericarditis that typically presents with persistent fever and pleuritis chest pain 2-3 weeks post-MI
  • symptoms resolve after several days

pericarditis immediately following MI is NOT considered dresslers syndrome

35
Q

what is the management of dresslers syndrome?

A

high dose aspirin

cardiology (17 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions