ACS 4 - Sx, Ex, DDx, Ix

Question 1

Sx - time? no relief with?
all same Sx as in first card on MIschaemia
no pain sometimes in ??

Answer 1

lasts over 20 minutes
GTN 3x5min spread
diab, elderly

Question 2

Ex - variable

• SNS activates - HR, BP, skin?
• or vagal stim - HR and ?
• myocardial impairment - pulse pressure? JVP? basal ?, possible ? HS
• tissue damage - low grade ?
• cardiac incompetence can give - ? rub, peripheral ?, ? murmur

Answer 2

incr hr, incr bp, sweat, pale
hr drop, vomiting
narrow, raised, creps, 3rd
pyrexia
pericardial, oedema, pansystolic

Question 3

DDx - cardiac - cor art ?, ?/myocarditis, aortic ?

non-cardiac - ??, oesophageal disease, ?, trauma, ?

Answer 3

spasm, peri, dissection

PE, costoch, pneumothorax

Question 4

Ix - most imp? - how often if in pain? or continuous in ACS due to high chance of ?
bloods - fbc for ?, u+e for ??, glucose can be ?, lipids may be ?, lastly?
CXR - looking for ?, pulm ?, widened ? in a dissection.
- what to use if unclear? or do what?

Answer 4

ECG, 15mins, arrhythmia
anaemia, acute phase, E- imb, low, raised, trop!
cardiomeg, oedema, mediastinum
ECHO, look for other Dx eg PE, pericarditis

Question 5

Enzymes - Trop - rise ?h after Sx
peak at?
detected for ?d
also raised in ? unwell from non-cardiac causes

Answer 5

4-8h after sx
24h
10d
critically unwell

Question 6

st changes in stemi
minutes - what happens to T waves?
half hour - ? becomes more and more ? like
2+ hours - what happens to t and q?
days - st?
weeks - t and q?

Answer 6

tall pointed t
st - saddled
t - inverted, q - develop
returns to normal
t may go back to norm, q stays

Question 7

what if chest pain with new onset LBBB?

Answer 7

assume MI - as further ECG interpretation is impossible

Question 8

stemi normally = ? thickness MI
nstemi normally = ? thickness MI
nstemi have no ? waves, may have other non-specific features

UA - may be isch ST ? in leads affected - with no ? rise due to no ?

Answer 8

full
partial
q

depression
trop
infarction