Acute Coronary Syndrome

Question 1

What is Acute Coronary Syndrome?

Answer 1

This compasses both Unstable Angina and Myocardial Infarction

Question 2

How is Unstable Angina Characterized

Answer 2

• New Onset Angina
• Worsening Angina (Crescendo)
• Angina on minimal exertion/at rest with no sign of myocardial ischemia

Question 3

What is the difference between stable and unstable angina

Answer 3

Stable (or chronic) angina – occurs when the heart is working harder than usual for example during exercise. It has a regular and predictable pattern and symptoms can be relieved by rest and medication. Unstable angina – occurs when at rest and follows an irregular pattern.

Question 4

What is the difference between unstable angina and myocardial infarction

Answer 4

Myocardial infarction has evidence of myocardial necrosis

Question 5

What are the criteria for diagnosing Acute Myocardial Infarction

Answer 5

1) Rise and/or fall of cardiac biomarker values (Troponin I/II)
with one value above99th centile upper reference limit (URL)

with at least one of the following:

1. Symptoms of ischaemia
2. New significant ST segment–T wave changes OR// new left bundle branch block (LBBB)
3. Development of pathological Q waves in the ECG
4. Imaging evidence of new loss of viable myocardium or new
   regional wall motion abnormality
5. Identification of an intracoronary thrombus by angiography or
   postmortem.

Question 6

What are the three criteria that diagnose previous myocardial infarction?

Answer 6

1) Pathological Q waves with or without symptoms in the absence of
non-ischaemic causes

2) Imaging evidence of a region of loss of viable myocardium that is
thinned and fails to contract, in the absence of a non-ischaemic
cause

3) Pathological findings of a prior myocardial infarction.

Question 7

List 5 symptoms of Acute Coronary Syndrome

Answer 7

• Prolonged Cardiac Pain (chest throat, arms, epigastrium, back)
• anxiety/fear of impending death
• nauseousness
• collapse/syncope
• breathlessness

Question 8

What are the five categories of physical signs of acute coronary syndrome

Answer 8

Signs of Sympathetic activation
Signs of vagal stimulation
Signs of impaired myocardial function
Low-grade fever
Complications

Question 9

List three Sympathetic Activation signs of ACS

Answer 9

Pallor
Sweating
Tachycardia

Question 10

List two Vagal Activation signs of ACS

Answer 10

Vomiting
Bradycardia

Question 11

List some Signs of impaired myocardial function in ACS

Answer 11

• Hypotension, oliguria, cold peripheries
• Narrow pulse pressure
• Raised jugular venous pressure
• Third heart sound
• Quiet first heart sound
• Diffuse apical impulse
• Lung crepitations