ACS

Question 1

What is classified under ACS?

Answer 1

• Unstable angina
• STEMI
• NSTEMI

Question 2

What is the pathogenesis of it?

Answer 2

Thrombous from an atherosclerotic plaque breaks off and deposits in the coronary artery. This leads to occlusion to the vessel and can lead to ischaemic death

Question 3

Investigations

Answer 3

ECG :

• STEMI
• Q Waves or Inverted T waves, ST inversion in an NSTEMI

Troponin
- Elevated in all three

Question 4

Chest pain features

Answer 4

• Central
• Crushing
• Radiation in Jaw and left arm
• SOB
• Palpitations
• N&V
• Feeling of impending doom

Question 5

Silent MI

Answer 5

when there is no chest pain symptoms in an MI

Question 6

Anterior-lateral heart.

Answer 6

ACS in Left coronary artery

I, AVL, V3-V6

Question 7

Anterior

Answer 7

ACS in LAD artery

v1- v4

Question 8

Lateral heart

Answer 8

LEFT CIRCUMFLEX

I, AVL, v5-v6

Question 9

Inferior aspect

Answer 9

RCA

II, III, AVF

Question 10

Troponin investigation

Answer 10

Base line and then at 6/12 hrs
Rise in troponin is consistent with Ischaemia
Troponin is released from the Ischaemia heart disease

Question 11

What else can lead to increase in troponin

Answer 11

CKF
Sepsis
Myocarditis
PE

Question 12

Investigations

Answer 12

BMI
ECG 
FBC- anaemia 
U&E s before medication 
Hb1AC for diabetes 
TFT
Lipid profile to look for cause
CXR- other causes of chest pain- pulmonary oedema 
ECHO- functional deficits in the heart 
CT coronary angiogram to look at the condition of the coronary arteries

Question 13

STEMI intervention

Answer 13

PCI- within 2 hours

Thrombolysis- within 12 hours- fibrinolytic agent e.g. streptokinase

Question 14

NSTEMI

Answer 14

BATMAN 
Beta blockers
Aspirin-300mg
Tecagralol/ clopidogrel (300ml)
Morphine 
Anticoagulants - LMWH
Nitrates- GTN spread 

Oxygen only if dropping saturation

Question 15

Greys score

Answer 15

6 month risk of death after having an NSTEMI
<5% low risk
5-10%- medium risk
>10% severe

Question 16

what is greys used for?

Answer 16

Assessment of whether a patient should have a PCI after a non-sTEMI

A score that is mild or medium is indicative of PCI- Within 4 of admission

Question 17

Complications

Answer 17

DREAD 
Death 
Rupture of heart septum
Edema- onset of HF 
Arrythmia
Dreslers syndrome/ Post MI syndrome

Question 18

Dreslers

Answer 18

Localised inflammation leading to peritonitis

• pleuritic pain
• Fever
• Pleuritic rub

Can lead to cardiac tamponade

Question 19

Secondary prevention

Answer 19

6 A
Aspirin (75-100mg)
Another anti-platelet e.g. clopidogrel 
Atovarastatin
ACE inhibitors- ramipril 
Atenolol/ beta blocker 
Aldosterone antagonist

Question 20

What does the RCA supply?

Answer 20

• RA
• RV
• Posterior septal area
• Inferior aspect of left ventricle

Question 21

What does the LDA supply?

Answer 21

• Anterior aspect of LV

- Anterior septal area

Question 22

What does the circumflex supply?

Answer 22

• LA

- Posterior aspect of LV