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CVS Pathologies - Summary > Acute coronary sundromes and acute myocardial infarction > Flashcards

Acute coronary sundromes and acute myocardial infarction Flashcards

1
Q

Non-cardiac causes of troponin rise

A

Pulmonary embolism
Sepsis
Renal failure
Sub-arachnoid haemorrhage

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2
Q

Other causes of MI not related to coronary atherosclerosis:

A
  • Coronary vasospasm
  • Coronary dissection
  • Embolism of the material down the coronary artery (thrombus from the mechanical valve, tumour, AF)
  • inflammation of the coronary arteries
  • Radiotherapy of the chest can cause fibrosis and stenosis of coronary arteries
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3
Q

Cardiac risk factors

A 
Male
age 
Known heart disease
High BP
High cholesterol 
Diabetes
Smoker
Family history of premature heart disease
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4
Q

Diagnosis of MI

A
  1. Detection of cardiac cell death = positive cardiac biomarkers
  2. AND one of
    - Symptoms of ischaemia
    - New ECG changes
    - Evidence of coronary problem on coronary angioplasm or autopsy
    - Evidence of new cardiac damage on another test
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5
Q

Thrombolysis

A

Tenecteplase (TNK) given as bolus

Older agents: streptokinase and altepase

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6
Q

Risks of thromboylsis

A

Bleeding
Don’t give if recent stroke, previous intracranial bleed
Caution if recent surgery, on warfarin, severe hypertension

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7
Q

General management of suspected ACS:

A

Admit to hospital
Cardiac monitor
Give o2 only if levels are low

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8
Q

Investigations for ACS

A

Serial ECGs - consider posterior leads
Blood tests
- Check not anaemic
- Check kidney function, cholesterol, thyroid

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9
Q

If have more chest pain

A

GTN

Opiates e.g. morphine

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10
Q

Pharmacological treatment of ACS

A 
Antiplatelet drugs
Anti-thrombotic drugs
Beta-blockers
Statins
ACE inhibitors
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11
Q

Risks of coronary angiography/angioplasty/stenting

A 
Bleeding
Blood vessel damage
Myocardial infarction
Coronary perforation
Stroke
Dye can affect kidneys ("contrast nephropathy")
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12
Q

Complications of MI

A 
Arrhythmia
Mechanical 
1. Cardiogenic shock
2. Myocardial rupture
Can lead to death
Other mechanical complications
1. Valve dysfunction due to papillary muscle dysfunction
2. Acute ventricular septal defect

Longer term complications

  • Higher risk of bleeding as on anti-platelet drugs
  • Increased risk of further myocardial infarction/death
  • Cardiac failure
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13
Q

Coronary arteries and MI

A

Right coronary artery: inferior MI
Left anterior descending artery: Anterior MI
Circumflex coronary artery: Lateral MI

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14
Q

Goal of therapy for ACS

A

Increase myocardial oxygen supply - through coronary vasodilation
Decrease myocardial oxygen demand
- Decrease HR
- Decrease BP
- Decrease preload or myocardial contractility

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15
Q

Fibrinolytics are divided into two categories

A
  1. Fibrin specific agents such as
    - Alteplase
    - Reteplase
    - Tenecteplase
  2. Non-fibrin specific agents such as streptokinase catalyse systemic fibrolytics
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16
Q

Contraindications for thrombolytic agents

A

Prior intracranial haemorrhage
Known structural cerebral vascular lesion
Known malignant intracranial neoplasm
Ischaemic stroke within 3 months
Suspected aortic dissection
Active bleeding or bleeding diathesis
Significant head closed trauma or facial trauma within 3 months

17
Q

ACS treatment protocol IF NO EVIDENCE OF STEMI

A 
Aspirin
Ticagrelor/clopidogrel
Fondaparinux/LMW heparin
IV nitrate
Analgesia
Beta blockers
Other;
- Pasugrel
- Gllblla receptor blockers
- Statins
18
Q

Management to reduce risk from NSTEMI

A 
PCI or CABG
Aspirin
Clopidogrel, prasugrel, ticagrelor, ticlopidine or cilostazol
Heparin (LMWH)
Gllb/llla receptor blockers
Statins
Beta Blockers
19
Q

LMW Heparin products

A

Enoxaparin
Dalteparin
Tinzeparin

20
Q

Treatment SIGN-148 of ACS

A

Immediately treated with aspirin and tSicagrelor
Dual anti-platelet therapy for 6 months
SHOULD NOT be offered rivaroxaban, apixaban or dabigatran in addition to dual anti-platelet therapy
Started on long term statin prior to hospital discharge

21
Q

Treatment SIGN-148 of unstable angina

A

Commenced on long term ACE inhibitors

22
Q

Treatment SIGN-148 of MI

A

Long term ACE inhibitors within the first 36 hours

MI with complicated LVD in the presence of either HF or DM should be commenced on long term eplerenone therapy

CVS Pathologies - Summary (19 decks)

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