IHD/ACS Flashcards
What are the ECG findings of an NSTEMI?
ST depression, T wave inversion, non-specific changes or normal ECG (non-Q wave or subendocardial MI).
What are the non-modifiable risk factors of ACS?
Age, male gender, family history of IHD (1st degree relative
What are the modifiable risk factors of ACS?
Smoking, hypertension, DM, hyperlipidaemia, obesity, sedentary lifestyle, cocaine use.
What is the underlying pathology of ACS e.g. unstable angina and MI?
Plaque rupture, thrombosis, inflammation. Occasionally it can be due to emboli, coronary spasm in normal coronary vessels or vasculitis.
What criteria must be fulfilled to diagnose an MI?
An increase and subsequent decrease in cardiac biomarkers e.g. troponin and either: symptoms of ischaemia, ECG changes of new ischaemia, development of pathological Q waves or loss of myocardium on imaging.
Name common symptoms of an MI.
Acute central chest pain, lasting >20 mins, often associated with nausea, sweatiness, dyspnoea and palpitations.
What are the features of a MI without chest pain i.e. ‘silent’ infarct?
Syncope, pulmonary oedema, epigastric pain and vomiting, post-operative hypotension or oliguria, acute confusional state, stroke, diabetic hyperglycaemic states.
Name two groups likely to experience ‘silent’ infarcts.
The elderly and diabetics.
What signs would you observe in a person experiencing an ACS?
Distress, anxiety, pallor, sweatiness, increase or decrease in pulse, decrease in BP, 4th heart sound. Signs of HF may be seen (e.g. increased JVP, 3rd heart sound, basal crepitations) or pansystolic murmur (papillary muscle dysfunction/rupture, ventricular septal defect). Low-grade fever may be present and a pericardial friction rub or peripheral oedema may develop later.
What tests would you do for a patient presenting with ACS symptoms?
ECG, bloods, CXR.
What ECG changes are often present in a patient having an MI?
Hyperacute (tall) T waves, ST elevation or new LBBB which occur a few hours after a transmural infarct. T wave inversion and pathological Q waves may develop over the subsequent days.
Name 3 cardiac enzymes that can be tested for in a suspected ACS?
Cardiac troponin, creatine kinase, myoglobin.
What key features would you look for on a CXR?
Cardiomegaly, pulmonary oedema, widened mediastinum (aortic rupture).
NB: don’t delay treatment for CXR.
What blood tests would you order for a patient who has symptoms of an ACS?
FBC, Urea and Electrolytes, cardiac enzymes, glucose, lipids.
What two key findings will determine the treatment of an ACS?
Whether there is ST-segment elevation and whether there is a rise in cardiac troponin.
