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MS4 - CVS > ACS > Flashcards

ACS Flashcards

1
Q

ACS includes?

A

Unstable angina
NSTEMI
STEMI

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2
Q

Pathophysiology of ACS

A

Plaque rupture

Thrombosis and inflammation

Rarely coronary spasm

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3
Q

Modifiable risk factors of ACS

A
  • HTN
  • DM
  • Smoking
  • ↑cholesterol
  • Obesity
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4
Q

Non-modifiable risk factors of ACS

A
  • age
  • male
  • FH (MI <55 years)
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5
Q

Sx of ACS

A
  • Radiates to left jaw or arm
  • Nausea
  • Sweating
  • Dyspnoea
  • Palpitations
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6
Q

Other symptoms for diabetic patients who may present without chest pain

A
  • Syncope
  • Delirium
  • Post-op oliguria / hypotension
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7
Q

Differential diagnosis of ACS

A

Angina

Peri- / Endo- / Myocarditis

Aortic dissection

PE

Pneumothorax

Pneumonia

GORD

Anxiety

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8
Q

ECG changes for STEMI

A
  • Normal
  • ST elevation
  • Q waves: full-thickness infarct
  • T wave inversion
  • New onset LBBB
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9
Q

ECG changes for NSTEMI

A
  • ST depression
  • T wave inversion
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10
Q

No Q waves on ECG indicates?

A

subendocardial infarct

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11
Q

Bloods for ACS

A

1) Troponin T/I
2) FBC, U+E, glucose, lipids, clotting

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12
Q

What is Troponin T/I?

A

Myofibrillar proteins linking actin and myosin

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13
Q

When to measure troponin

A

Elevated from 3-12h
Need 12h trop to exclude MI
Peak 24h

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14
Q

CXR for suspected ACS

A
  • Cardiomegaly
  • Pulmonary oedema
  • Widened mediastinum: aortic rupture
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15
Q

When to diagnose unstable angina

A
  • typical symptoms
  • no ST elevation
  • negative troponin
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16
Q

Rx of STEMI

A

PCI or thrombolysis

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17
Q

Rx of NSTEMI or unstable angina

A

Medical + elective angioplasty ± PCI/CABG

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18
Q

ECG criteria for thrombolyis

A
  • ST elevation > 1mm in 2+ limbs

or > 2mm in 2+ chest leads.

  • New LBBB
  • Posterior: Deep ST “depression” and tall “R” waves in V1-V3
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19
Q

Flow chart of STEMI management

A

1) 12 lead ECG
2) O2
3) IV access + bloods
4) Brief assessment
5) Aspirin 300mg
6) Morphine + anti-emetic
7) Nitrates
8) LMWH
9) Admit to CCU
10) PCI / thrombolysis

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20
Q

Complications of PCI

A
  • Bleeding
  • Emboli
  • Arrhythmia
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21
Q

CIs of thrombolysis

A

Severe HTN (200/120)

Aortic dissection

GI bleeding

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22
Q

Agents used in thrombolysis

A

Alteplase

Rh t-PA

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23
Q

What should patients not receiving any form of reperfusion therapy be given?

A

fondaparinux

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24
Q

Continuing therapy following STEMI

A

Aspirin 300mg 2 wks

Then clopidogrel 75mg (1 month) + aspirin 75mg (lifelong)

ACEi within 24hrs of MI

Beta blocker

Statin

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25
Q

Advice following STEMI

A
  • Stop smoking
  • Diet
  • Exercise
26
Q

How long to avoid work post MI?

A

2 months

27
Q

How long to avoid sex post MI?

A

1 month

28
Q

How long to avoid driving post MI?

A

4 wks

(6 wks if bus or lorry driver)

29
Q

Complications of MI

DRAPPED

A

Death

Rupture

Arrythmias / Aneurysm

Pericarditis

Pump failure

Embolism

Dressler’s syndrome

30
Q

Causes of death from MI

A

VF
LVF

Stroke

31
Q

Presentation of pericarditis following MI

A
  • Occurs early
  • Mild fever
  • Central chest pain / change in pain
  • Relieved by sitting forward
  • Pericardial friction rub
32
Q

ECG changes of pericarditis following MI

A
  • Saddle-shaped ST elevation
  • ± PR depression
33
Q

Treatment of pericarditis following MI

A
  • NSAIDs (ibuprofen)
  • Echo to exclude effusion
34
Q

Types of rupture following MI

A
  • Cardiac tamponade
  • Papillary muscle/chordae → Mitral Regurgitation
  • Septum
35
Q

Features of septum rupture

A
  • pansystolic murmur
  • ↑JVP
  • Heart failure
36
Q

Types of tachycardias following MI

A

SVT

VT

37
Q

Types of bradycardia following MI

A

Sinus bradycardia

AV block

Ventricular bradycardia

38
Q

Presentation of ventricular aneurysm following MI

A
  • 4-6wk
  • LVF
  • Angina
  • Recurrent VT
  • Systemic emboli
39
Q

ECG changes consistent with ventricular aneurysm

A

persistent ST elevation

40
Q

Rx for ventricular aneurysm following MI

A
  • Anticoagulate
  • consider excision
41
Q

Definition of Dressler’s syndrome

A

Pleuropericarditis

42
Q

Cause of Dressler’s syndrome

A

Auto-antibodies vs myocyte sarcolemma

43
Q

Presentation of Dressler’s syndrome

A

2-6wks

  • Recurrent pericarditis
  • Pleural effusions
  • Fever
  • Anaemia
  • ↑ESR
44
Q

Rx of Dressler’s syndrome

A
  • NSAIDs
  • steroids if severe
45
Q

Causes of IHD

A

Atheroma

Anaemia

AS

Arteritis

46
Q

RFs for IHD

A

HTN
DM
Smoking
Hypercholesterolaemia
Obesity
Age
Male
FH of MI <55yrs
Hyperlipidemia

47
Q

Sx of IHD

A

Central crushing chest pain

Relieved by rest

Radiation to left arm/jaw

48
Q

Classification of angina

A

Stable

Unstable

Decubitus

Prinzmetal’s / variant

Syndrome X

49
Q

Stable angina definition

A

Induced by exercise

50
Q

Unstable angina definition

A

Occurs at rest

51
Q

Decubitus angina definition

A

Induced by lying down

52
Q

Prinzmetal’s angina definition

A

Occurs at rest

Due to coronary spasm

53
Q

ECG changes in Prinzmetal’s angina

A

ST elevation during attack

Resolves as pain subsides

54
Q

Syndrome X angina definition

A

Angina pain + ST elevation on exercise test

No evidence of coronary atherosclerosis

Probably represents small vessel disease

55
Q

Differentials of angina

A

AS

Aortic aneurysm

GORD

56
Q

Secondary prevention of CHD

A

Aspirin 75mg OD
ACEi
Statins
Antihypertensives

GTN PRN

57
Q

Anti-anginal medication

A

GTN + B blocker or Ca channel blocker

58
Q

CABG indications

A

L main stem disease
Triple vessel disease
Refractory angina
Unsuccessful angioplasty

59
Q

PCI indications for angina

A

Poor response to medical Rx

Not suitable for CABG

60
Q

Diltiazem

A

Ca channel blocker

61
Q

Verapamil

A

Ca channel blocker

MS4 - CVS (8 decks)

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