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cardiovascular > acute coronary syndrome > Flashcards

acute coronary syndrome Flashcards

1
Q

where is heart disease in the causes of death in Scotland

A

the second most common cause of death in Scotland

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2
Q

what is acute coronary syndrome

A

Any sudden cardiac event suspected or proven to be related to a problem with the coronary arteries

leading to myocardial ischemia

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3
Q

what causes a major MI

A

due to a complete coronary artery occlusion

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4
Q

what causes a minor MI

A

due to a partial (or transient complete) coronary artery occlusion

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5
Q

on a ECG what are the sings of complete coronary occlusion

A

initially - ST elevation

at 3 days - Q waves

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6
Q

on a ECG what are the signs of partial coronary occlusion

A

initially - no ST elevation

3 days - NO Q waves

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7
Q

what is classed under acute coronary syndrome

A

unstable angina

MI

STEMI
NSTEMI

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8
Q

why is STEMI seen as worse than NSTEMI

A

it damages the full thickness of the heart (transmural vs subendocardial)

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9
Q

how do you diagnose a MI

A

detection of cardiac cell death

and one of the following
symptoms of ischemia
new ECG changes
evidence of coronary problems

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10
Q

how can you detect cardiac cell death

A

troponin - +ve cardiac biomarkers

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11
Q

what are some non cardiac causes of troponin rise

A

pulmonary embolism

sepsis

renal failure

sub-arachnoid haemorrhage

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12
Q

what are the type of MI

A 
type 1
2
3
4a
4b
5
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13
Q

what is type 1

A

spontaneous MI - with ischemia - due to primary coronary event ie thrombosis

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14
Q

what is a type 2 MI

A

due to imbalance of supply and demand of O2

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15
Q

what is type 3 MI

A

sudden cardiac death

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16
Q

what is type 4a/b MI

A

associated with coronary intervention(a) or angiogram (b)

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17
Q

what is type 5 MI

A

MI associated with CABG

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18
Q

what can cause type 1 MIs

A

coronary atherosclerosis
coronary vasospasm
coronary dissection
inflammation of CAs

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19
Q

what can cause coronary vasospasms

A

cocaine, triptans (anti-migraine meds)

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20
Q

what can cause coronary dissection

A

spontaneous - often young healthy females

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21
Q

what causes inflammation of the coronary arteries

A

vasculitis

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22
Q

what coronary artery occlusion can be easily missed why

A

LCx (left circumflex coronary artery) as there can be little change on the ECG

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23
Q

what might be needed to detect a posterior

A

ECG leads V7, V8, V9

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24
Q

when are hyperacute T waves seen

A

at the early stages of complete coronary occlusion

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25
Q

what are the cardiac risk factors

A 
male 
old 
known Heart disease 
High BP 
high cholesterol 
diabetes
smoker 
fam history
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26
Q

what is the treatment for STEMI

A

to get the coronary artery open ASAP

reperfusion therapy

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27
Q

what are the two types of reperfusion therapy

A

mechanical in the cath lab - primary PCI

pharmacological

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28
Q

what are the pharmacological treatments that can be used

A

thrombolysis - tenecteplase (TNK) given as a bolus

29
Q

what are the risks of thrombolysis

A

bleeding

don’t give if recent stroke, previous intercranial bleed

caution if have had warfarin

30
Q

what does PCI stand for

A

percutaneous coronary intervention

31
Q

what does PCI do

A

treats coronary stenosis

expand a balloon and deploy a stent to press the plaque out and widen the artery

32
Q

what is your preffered treatment for a STEMI

A

PCI if can get to a cath lab in under 2 hours

33
Q

what are the pros and cons of thrombolysis

A

works if gioven early
more likely to cause bleeding
may not wotk - especially if there is delayed presentation

34
Q

compared to STEMI what are NSTEMI patients more likely to be

A

older
more likely to have had previous MI
more likely to have had previous CABG/PCI

may not be as clear presentation

35
Q

what pharmacological drugs can be given

A 
antiplatelet drugs 
thrombolytic drugs 
beta blockers
statin 
ACE inhibitors
36
Q

what are exampels of anti platlet drugs

A

aspirin

ticagrelor

37
Q

what are examples of anit-thrombotic drugs

A

heparin
low molecular weight heprin

FONDAPARINUX

38
Q

what does CABG stand for

A

coronary artery bypass graft

39
Q

what are the complications after a MI

A

arrhythmia
mechanical - cardiogenic shock, myocardial rupture

valve dysfunction - papillary muscle rupture

AV septal defect

40
Q

what is the post operative care needed for PCI and stents

A

need dual anti platelet therapy

for up to 12 months

premature discontinuation of DAPT is fatal

41
Q

how do thrombolytic agents work

A

by converting plasminogen to the natural fibrinolytic agent plasmin.

42
Q

what does plasmin do

A

lyses clot by breaking down the fibrinogen and fibrin contained in a clot

43
Q

what is a example of a thrombolytic agent

A

alteplase,

44
Q

what are some contraindications for thrombolytic agents

A

active bleeding

prior intercranial haemorrhage

previous stroke in 3 months

45
Q

what are the benefits of thrombolytic drugs

A

23% reduction in mortality

46
Q

how does a 23% reduction in mortality

increase

A

when used with aspirin to 39%

47
Q

what is the treatment for ACS with STEMI

A

thrombolytic agent with aspirin

48
Q

what is the treatment for ACS with no STEMI (therefore NSTEMI)

A

aspirin

Tigagrelor/Clopidogrel

LMW heparin

Intravenous nitrate

Analgesia

Beta Blockers

49
Q

what are the benefit of regular uses of antiplatelet therapy (aspirin)

A

reduction in MI mortality 20%

reduction of mortality in general for CV diseases

50
Q

what is clopidgrel

A

a prodrug

stops platelet activation

51
Q

what should you always do with clopidogrel

A

use it in combination with aspirin (DAP)

52
Q

what are beta blockers used for

A

treatment of MI

secondary prevention of further MIs

53
Q

what do beta blockers do

A

reduce myocardial O2 consumption

54
Q

what are STEMIs likely to be

A

coronary thrombus

55
Q

what is the problem with clopidigrel

A

14% of the population are resistant

56
Q

if a patient is at risk of developing cardiogenic shock what should you do

A

NOT GIVE THEM BETA BLOCKERS

57
Q

what is cardiogenic shock

A

severely damaged heart - often by MI - cant pump blood

58
Q

what are some ECG sings for a NSTEMI and unstable angina

A

ST elevation

59
Q

what are the symptoms of stable angina

A

central chest tightness, often radiating to the neck/ arms

aggravated by exertion and stress

60
Q

when do ACS (acute coronary syndromes) occur compared to stable angina

A

ACS symptoms will always be at rest stable angina sometimes on exertion

61
Q

when is cardiac troponin detected

A

when the myocyte integrity is compromised

62
Q

what is the immediate treatment of unstable angina and NSTEMI

A

ABCDE

MONA

63
Q

what does MONA stand for

A

morphine
oxygen
nitro-glycerine (GTN)
aspirin (DAPT)

64
Q

what is asprin - what is it used with

A

antiplatelet therapy

clopidogrel

65
Q

what is the pathophysiology of STEMI

A

necrosis of myocardial tissue caused by coronary occlusion

66
Q

what is the primary treatment for STEMI

A 
fibrinolysis or 
primary PCI (Percutaneous Coronary Intervention)
67
Q

when is PCI most effective

A

within 90mins

68
Q

what are the 2ndry treatments for STEMI

A

aspirin and clopidogrel

beta blockers

69
Q

what is the main complication of MI

A

free wall rupture

cardiovascular (26 decks)

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