CARDIOLOGY - ACUTE CORONARY SYNDROME

Question 1

What is acute coronary syndrome ?

Answer 1

A group of syndromes that resulted form myocardial ischaemia.

Question 2

What is Myocardial ischaemia ?

Answer 2

Imbalance between supply and demand of the heart for oxygenated blood

Question 3

3 examples of acute coronary syndrome ?

Answer 3

-ST elevation Myocardial Infarction
-Non ST elevation Myocardial Infarction
-Unstable angina

Question 4

What should you do first when the patient come with chest pain ?

Answer 4

ECG (within 10 mins of arriving)

Question 5

How the patient usually describe chest pain ?

Answer 5

Pressure & Tightness or burning-like

-Chest pain may also radiates to the :
-epigastrium
-left shoulder
-arm neck and lower jaw

Question 6

What is the relevant medical history you expect ?

Answer 6

-hypertension
-dyslipidemia
-diabetes
-tobacco use
-family history

Question 7

When there is more myocardial damage , what did you suspect the patient will experience ?

Answer 7

-decrease in cardiac output
-may show signs of cardiogenic shock
>hypotension
>tachycardia
>diaphoresis
>cool extremities
>pale skin

Question 8

Besides cardiogenic shock , what can the patient have when there is more myocardial damage ?

Answer 8

Evidence of acute heart failure
>jugular venous distension
>murmur
>orthopnea
>edema

Question 9

What is the emergency drug treatment in ACS

Answer 9

MONAC
-Morphine ( opiods- painkillers for severe chest pain )
-Oxygen supplementation
-Nitrates (sublingual / IV , vasodilators )
Aspirin (antiplatelet , to prevent complete thrombosis )
-Clopidogrel (antiplatelet , more effective antiplatelet therapy)

Question 10

For STEMI , what did you suspect the findings of ECG ?

Answer 10

-ST elevations in 2 contiguous leads

Question 11

Regarding reperfusion , when do you want to consider this therapy?

Answer 11

<12 hours since symptoms started
-so no large scale of reperfusion injury

Question 12

Before you want to do PCI , what would you do first and why ?

Answer 12

Coronary angiography
-to detect the number and degree of coronary artery blockage

Question 13

Why fibrinolytic therapy is contraindicated in patient with high risk of hemorrhage ?

Answer 13

Fibrinolytic therapy works by dissolving blood clots throughout the body, not just in the specific area where the clot is causing the problem. This means that patients who receive fibrinolytic therapy are at an increased risk of bleeding anywhere in the body, including the brain.

Question 14

What are the criteria need to be fullfilled to call the agina as a TYPICAL ANGINA ?

Answer 14

• constricting discomfort in front of the chest or in the neck , jaw , shoulder or arm
• precipitated by physical exertion
• relieved by rest or nitrated

all three need to be fullfilled to call it as a TYPICAL ANGINA