ACS & AMI - Presentation & Investigation Flashcards Preview

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Flashcards in ACS & AMI - Presentation & Investigation Deck (90):
1

What does ACS stand for?

Acute coronary syndrome

2

What is acute coronary syndrome?

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

3

What is any sudden event suspected or proven to be related to a problem with the coronary arteries called?

Acute coronary syndrome

4

What is myocardial ischaemia?

Reduction in the blood supply to the heart muscle

5

What is reduction in the blood supply to the heart muscle called?

Myocardial ischaemia

6

What is 2?

Right coronary artery

7

What is 3?

Left anterior descending coronary artery

8

What is 4?

Circumflex coronary artery

9

What is 5?

Left coronary artery

10

What does AMI stand for?

Acute myocardial infarction

11

What is acute myocardial infarction?

Cell death due to ischaemia

12

What is cell death due to ischaemia called?

Acute myocardial infarction

13

What cause of death is heart disease in Scotland?

2nd most common cause of death

14

What can acute myocardial infarction be due to?

Complete or partial coronary artery occlusion

15

What is cardiac arrest?

Abnormal heart rhythm that is not compatible with life

16

What is an abnormal heart rhythm that is not compatible with life called?

Cardiac arrest

17

What are examples of cardiac arrest?

Ventricular fibrillation or tachycardia

Asystole

18

What is asystole?

Cardiac flatline so total state of cessation of electrical activity from the heart, more serious form of cardiac arrest and usually irreversible

19

What is a cardiac flatline, so total state of cessation of electrical activity from the heart called?

Asystole

20

When can cardiac arrest occur in relation to myocardial infarction?

Can occur during the acute phase or later afterwards

It may also be unrelated to myocardial infarction

21

What is a 'heart attack'?

Public use to cover all manner of sudden cardiac onset

22

What is a word the public use to cover all manner of sudden cardiac events?

Heart attack

23

What do doctors usually think heart attack means?

Myocardial infarction

24

What is the process of the evolution of atherosclerosis?

1) Foam cells

2) Fatty streak

3) Intermediate lesion

4) Atheroma

5) Fibrous plaque

6) Complicated lesion/rupture

25

What is an example of chronic ischaemic heart disease vs examples of acute coronary syndrome?

Chronic ischaemic heart disease - stable angina

Acute coronary syndromes - unstable angina, myocardial infarction (STEMI and NSTEMI)

26

What is the difference in the blockage of arteries in chronic ischaemic heart disease and acute coronary syndromes?

Chronic ischaemic heart disease (such as stable angina) - less of lumen blocked

Acute coronary syndromes (such as unstable angina then myocardial infarction) - more of lumen blocked

27

How does complete coronary occlusion affect the ECG initially and after 3 days?

 

Initially - ST elevation

After 3 days - Q waves

28

How does partial coronary occlusion affect the ECG initially and after 3 days?

Initially - no ST elevation

After 3 days - no Q waves

29

How does the thickness of the damage to the heart muscle change for STEMI and NSTEMI?

NSTEMI - only partial thickness damage of the heart muscle

STEMI - full thickness damage of the heart muscle

30

What is other terminology for STEMI myocardial infarction?

Q wave MI

Transmural MI

31

What is other terminology for NSTEMI myocardial infarction?

Non Q wave MI

Subendocardial MI

32

What does the diagnosis of myocardial infarction require?

Detection of cardiac death/injury

and one of:

Symptoms of ischaemia
New ECG changes
Evidence of coronary problem on coronary angiogram or autopsy
Evidence of new cardiac damage on another test

33

How can cardia death/injury be detected?

Cardiac biomarkers

34

What are examples of different cardiac biomarkers?

Myoglobin

Troponin

CK-MB

35

Is more troponin present in STEMI or NSTEMI myocardial infarction?

STEMI

36

Does troponin increase always mean myocardial infarction?

No, there are many other causes

37

Other than myocardial infarction, what other things could cause an increase in troponin?

Pulmonary embolism

Cardiac contusion

Anaemia

Sepsis

Renal failure

Sub-arachnoid haemorrhage

38

What is cardiac contusion?

Bruise of the heart muscle

39

What is a bruise of the heart muscle called?

Cardiac contusion

40

What are the different categories of myocardial infarction?

1

2

3

4a

4b

5

41

What is a type 1 myocardial infarction?

Spontaneous MI associated with ischaemia adn due to primary coronary event

42

What is a type 2 myocardial infarction?

Due to imbalance in supply and demand of oxygen, not ischaemia due to coronary event

43

What is a type 3 myocardial infarction?

Sudden cardiac death, with symptoms of ischaemia accompanied by new ST elevation

Verified coronary thrombus after death

44

What is a type 4a myocardial infarction?

MI associated with percutaneous coronary intervention

45

What is a type 4b myocardial infarction?

MI associated with verified stent thrombosis via angiography or autopsy

46

What is a type 5 myocardial infarction?

MI associated with CABG

47

What could cause a type 1 myocardial infarction?

Coronary atherosclerosis

Coronary vasospasm

Coronary dissection

Embolism of material down coronary artery

Inflammation of coronary artery

Previous radiotherapy to chest causing fibrosis and stenosis of coronary arteries

48

What could cause a coronary vasospasm?

Cocaine

Triptans

5-FU

49

Who usually suffers from coronary dissection?

Younger, healthy females

50

What could cause inflammation of coronary arteries?

Vasculitis

51

What is seen in the history for acute coronary syndrome?

Chest pain (may radiate to neck/arm)

Nausea

Sweating

Breathlessness

52

What are some risk factors for acute coronary syndrome?

Male

Age

Known heart disease

Known high blood pressure

High cholesterol

Diabetes

Smoker

Family history

53

54

Are males or females more at risk of acute coronary syndrome?

Males

55

What are some examination findings for acute coronary syndrome?

Look completely fine or very unwell

No specific features to find

Ensure you check heart rate, blood pressure and listen for murmurs and crackles in the chest

56

What are key investigations for acute coronary syndrome?

ECG

57

What does an ECG tell you about acute coronary syndrome?

Where the problem is

58

What are some different locations of myocardial infarction?

Lateral

Anterior

Posterior

59

Why can posterior myocardial infarctions easily be missed?

No ECG leads on posterior chest

60

What is a STEMI myocardial infarction caused by?

Completely occluded artery

61

What does STEMI myocardial infarction cause?

Ongoing myocyte death

62

What is the treatment for STEMI myocardial infarction?

Get coronary artery open as soon as possible:

 

Angioplasty (mechanical)

Thrombolysis (pharmacological)

63

What are some risks of thrombolysis?

Bleeding

Don't give if recent stroke or ever had a previous intracrainal bleed

Caution if recent surgery, on warfarin, severe hypertension

64

When should thrombolysis never be given?

If had a recent stroke or ever had a previous intracranial bleed

65

When does thrombolysis work best?

When given earlier

66

What is generally the best option for treating STEMI myocardial infarction?

Angioplasty unless cannot get to the lab within 2 hours - then thrombolysis

67

Compared to STEMI, what do NSTEMI patients tend to be?

Older

More likely to have previous MI

More likely to have other medical problems

68

What are signs of unstable angina?

Rapidly worsening

Occuring at rest

ECG may be normal or abnormal

No cell death so troponins will not be raised

69

What is the process of general management for acute coronary syndrome?

1) Admit to hospital

2) Cardiac monitor

3) Give oxygen only if levels are low

70

What investigations are done for acute coronary syndrome?

ECG (consider doing posterior leads)

Blood tests (check troponin, Hb, kidney function and cholesterol)

71

What should be check in blood tests for acute coronary syndrome?

Troponin

Haemoglobin

Kidney function

Cholesterol

72

What is the treatment for acute coronary syndrome?

Glycerol trinitrate (GTN)

Opiates

Anti-thrombotic drugs

Beta blockers

Statin

ACE inhibitors

73

What does GTN stand for?

Glycerol trinitrate

74

What effect does glycerol trinitrate (GTN) have?

Vasodilator (opens up coronary arteries)

75

How can GTN be administered?

Sublingual or IV infusion

76

What is an example of an opiate?

Morphine

77

Why are opiates given for acute coronary syndrome?

Relieves anxiety

Helps venodilate

78

What are the different categories of anti-thrombotic drugs?

Anti-platelet drugs

Anti-coagulant drugs

79

What are examples of anti-platelet drugs?

Aspirin

Clipidogrel

80

What are examples of anti-coagulant drugs?

Heparin

Low molecular weight heparin (LMWH)

Fondaparinux

81

Why are beta blockers used for acute coronary syndrome?

Reduces the work the heart has to do

82

What do statins do?

Lower cholesterol

83

Why are ACE inhibitors given for acute coronary syndrome?

Helps the heart muscle recover

84

Do patients with an NSTEMI myocardial infarction always need a coronary angiogram?

They often do, use common sense

85

What are some risks of coronary angiography and angioplasty/stenting?

Bleeding

Blood vessel damage

Myocardial infarction

Coronary perforation

Stroke

Dye affecting kidney function (contrast neuropathy)

86

What does PCI stand for?

Percutaneous coronary intervention

87

What does CABG stand for?

Coronary artery bypass graft

88

What surgical options are there for revascularisation?

Percutaneous coronary intervention (PCI)

Coronary artery bypass graft (CABG)

89

What are some possible complications following myocardial infarction?

Arrhythmia

Mechanical such as myocardial rupture, acute ventricular septal defect and mitral valve dysfunction due to papillary muscle rupture)

90

What are some possible longer term consequences following myocardial infarction?

High risk of further myocardial infarction/death

Cardiac failure

Risk of bleeding as on anti-platelet drugs

Potential delay in getting other operations when on anti-platelet drugs

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