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Cardiovascular System > ACS & AMI - Presentation & Investigation > Flashcards

ACS & AMI - Presentation & Investigation Flashcards

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1
Q

What are the four main acute coronary syndromes (ACS)?

A

STEMI
NSTEMI
unstable angina
sudden cardiac death (SCD)

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2
Q

An ACS causes problems due to the effects of ________ _________.

A

myocardial ischaemia

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3
Q

Myocardial infarction (MI) implies cell death due to _________ _________.

A

prolonged ischaemia

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4
Q

What is cardiac arrest?

What are features of a cardiac arrest? (3)

A

Abnormal heart rhythm not compatible with life.

Ventricular fibrillation
Ventricular tachycardia
Asystole

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5
Q

Is a cardiac arrest the same as an MI?

A

Not necessarily, a cardiac arrest can occur during the acute phase of MI, in the late stage or be unrelated at all.

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6
Q

What are the three main coronary arteries affected in MI?

A
  • left anterior descending (LAD) artery
  • right coronary artery (RCA)
  • circumflex artery
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7
Q

What stage of atherosclerosis results in stable angina?

3

A
  • there is a stable fixed plaque, some occlusion but not completely blocked.
  • fibrous cap acts as protection.
  • no rupture or thrombus production.
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8
Q

What ACS’s are the diagnosis when there is thrombus present in the coronary artery?

A

STEMI

NSTEMI

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9
Q

Is stable angina is not considered an ACS, what is it?

A

chronic ischaemic heart disease

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10
Q

What would be picked up on an initial ECG where there is complete coronary occlusion?

What type of ACS is this?

A

ST elevation

STEMI

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11
Q

What would be picked up on an initial ECG where there is partial coronary occlusion?

What type of ACS is this?

A

No ST elevation
(ST depression)

NSTEMI

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12
Q

What has likely been the ACS if no pathological Q waves are picked up on an ECG 3 days following initial ECG?

A

NSTEMI

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13
Q

If an ECG is showing pathological Q waves, what is the likely cause?

A

There has been a STEMI (transmural MI)

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14
Q

What are the other clinical terms for STEMI/NSTEMI?

A

STEMI: transmural MI

NSTEMI: subendocardial MI

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15
Q

What main investigations are used to diagnose a MI?

2

A
  • bloods

- ECG

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16
Q

What blood result would indicate a recent/ongoing MI?

be specific

A
  • increased troponin

Troponin I, Troponin T

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17
Q

Which troponin is indicative of STEMI?

A

B1/Troponin I

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18
Q

Which troponin is indicative of NSTEMI?

A

B2/Troponin T

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19
Q

What are other causes of increased troponin levels, other than coronary artery disease?

(5)

A
  • arrhythmia
  • cardiac contusion
  • renal failure
  • sepsis
  • pulmonary embolism
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20
Q

Briefly, what defines a type I MI?

2

A
  • spontaneous MI

- associate with ischaemia due to thrombus, rupture, fissuring or dissection.

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21
Q

Briefly, what defines a type II MI?

2

A
  • imbalance in O2 supply and demand

- ischaemia, but not due to thrombosis.

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22
Q

Briefly, what defines a type III MI?

2

A
  • sudden cardiac death

- confirmed iscahemia, thrombus on angiogram or autopsy.

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23
Q

What are causes of type I MI other than atherosclerosis?

4

Study These Flashcards
A
  • vasospasm
  • coronary dissection
  • embolism (air, fat)
  • vasculitis (inflammation)
24
Q

What information can be gathered from the history which points to MI?

(4/5)

Study These Flashcards
A
  • chest pain (more like a discomfort)
  • pain radiation (jaw, arm)
  • severe, but not agony

associated symptoms: SOB, sweating, nausea

25
What are the common cardiac risk factors? | 8
- Male - Age - Known heart disease - High BP - High cholesterol - Diabetes - Smoker - FHx of premature heart disease
26
What should be included in the examination of a patient with suspected MI? (2)
- BP, HR (both arms) | - auscultation
27
What should you listen for on auscultation of the heart? | 2
murmurs or crackles
28
What findings on an ECG may be indicative of a STEMI? | 2
ST elevation | pathological Q waves
29
What findings on an ECG may be indicative of a NSTEMI? | 4
ST depression inverted T waves No Q waves May be normal
30
An inferior MI indicates occlusion of which coronary artery?
RCA
31
A posterior MI indicates occlusion of which coronary artery?
circumflex branch
32
An anterior MI indicates occlusion of which coronary artery?
LAD artery
33
Which MI can be easy to miss on an ECG?
posterior MI/circumflex branch
34
Which ECG leads are used to detect anterior MI?
V1, V2, V3, V4
35
Which ECG leads are used to detect inferior MI?
SLL 2, SLL 3, aVF
36
Which ECG leads are used to detect a lateral MI?
V5, V6
37
Which ECG leads are used to detect a high lateral MI?
SLL 1, aVL
38
What could be changed in order to detect a posterior MI more easily?
- Position leads on back | - see opposite results on opposite leads (i.e. V1, V2)
39
What is the surgical treatment options for MI? Would this be used in STEMI or NSTEMI?
PCI (percutaneous coronary intervention) STEMI mainly, NSTEMI possibly but not immediately important.
40
If a NSTEMI patient was not having immediate PCI, how would they be treated? (2)
- fondaparinux | - LMWH s/c
41
What treatment option would be required if a patient was not near a cath lab for PCI? Which drug might be used for this?
thrombolysis tenecteplase (TNK)
42
What risks are associated with thrombolysis? When should it not be given to patients? (3)
- bleeding - recent stroke or previous intercranial bleeding - on warfarin - recent surgery - severe hypertension
43
What are classical symptoms of unstable angina? How will an ECG appear? How will troponin be affected?
- chest pain at rest - rapidly worsening normal or abnormal unchanged - no cell death
44
As well as checking troponin blood levels, what other blood tests should be investigated? (3)
- Hb - cholesterol - kidney function
45
What is the pharmacological treatment for MI?
MONA B - Morphine - Oxygen (if hypoxic) - Nitrate (GTN) - Anticoagulants/antiplatelett - Beta-blockers
46
What antiplatelet might be prescribed? What other medicine might be given along with this? (hint: it begins with a)
aspirin antiemetic
47
What are other antiplatelet drugs that may be prescribed? (hint: __grel) (3)
Clopidogrel | Ticagrelor Prasugrel
48
What anticoagulant drugs are used in treating MI? | hint: to treat NSTEMI before PCI
- heparin - LMWH - fondaparinux
49
What drugs are prescribed to MI patients on discharge? | 4
- aspirin - ACE inhibitor - beta-blocker (or CCB) - statin
50
What risks are associated with coronary angiogram and PCI? | 6
- Bleeding from access site - Blood vessel damage - MI - Coronary perforation - Stroke - Contrast nephropathy
51
If PCI was an unsuitable surgical option, what else may be considered?
CABG
52
What are post-MI complications?
C PEAR DROP Cardiac arrhythmia/shock Pericarditis Emboli Aneurysm Rupture of ventricle Dressler's syndrome Rupture of free wall Papillary muscle rupture
53
How does AF present? (2) What does it increase patient risk of?
- irregularly irregular pulse - ECG no P waves, narrow QRS complex Stroke
54
What can myocardial rupture lead to (rupture of free wall)?
cardiac tamponade
55
What can papillary muscle rupture lead to?
mitral regurgitation
56
Elevated troponin indicates what?
myocardial cell death, MI
57
What is the most important investigation in MI?
ECG

Cardiovascular System (37 decks)

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