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Y4 Acute Care > Acute Coronary Syndrome > Flashcards

Acute Coronary Syndrome Flashcards

1
Q

What is ACS?

A

Umbrella term for acute diseases of ischaemic heart disease

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2
Q

What are the 3 diseases in ACS?

A
  1. STEMI
  2. NSTEMI
  3. Unstable angina
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3
Q

What are the risk factors for ACS? (8 things)

A
  1. Age
  2. Male
  3. FHx
  4. Smoking
  5. DM
  6. Obesity
  7. HTN
  8. Hypercholesterolaemia
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4
Q

What are the clinical features of ACS? (6 things)

A
  1. Central crushing chest pain
  2. Pain radiation to jaws / arms
  3. SOB
  4. Feeling of impending doom
  5. Palpitations
  6. Nausea + vomiting

(Symptoms @ rest for 20 mins +)

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5
Q

What does the Right Coronary Artery supply? (4 things)

A
  1. Right atrium
  2. Right ventricle
  3. Inferior aspect of Left Ventricle
  4. Posterior aspect of septum
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6
Q

What does the Left Coronary Artery give off? (2 things)

A
  1. Circumflex Artery
  2. Left Anterior Descending (LAD)
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7
Q

What does the Circumflex Artery supply? (2 things)

A
  1. Left atrium
  2. Posterior aspect of Left ventricle
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8
Q

What does the Left Anterior Descending Artery supply? (2 things)

A
  1. Anterior aspect of Left ventricle
  2. Anterior aspect of septum
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9
Q

What artery is the Right atrium supplied by?

A

Right Coronary Artery

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10
Q

What artery is the Right ventricle supplied by?

A

Right Coronary Artery

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11
Q

What artery is the Left Atrium supplied by?

A

Circumflex Artery (branch of LCA)

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12
Q

What artery is the Anterior aspect of the Left Ventricle supplied by?

A

Left Anterior Descending Artery (LAD) (branch of LCA)

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13
Q

What artery is the Posterior aspect of the Left Ventricle supplied by?

A

Circumflex Artery (branch of LCA)

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14
Q

What artery is the Inferior aspect of the Left Ventricle supplied by?

A

Right Coronary Artery

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15
Q

What artery is the Anterior aspect of the septum supplied by?

A

Left Anterior Descending Artery (LAD) (branch of LCA)

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16
Q

What artery is the Posterior aspect of septum area supplied by?

A

Right Coronary Artery

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17
Q

What investigations should you do in sus ACS? (5 things)

A
  1. ECG
  2. CXR
  3. Blood
  4. Cardiac enzymes
  5. Echo
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18
Q

What are the ECG changes in a STEMI? (3 things)

A
  1. ST elevation (in leads of area of ischaemia)
  2. New LBBB
  3. Pathological Q wave
19
Q

What are the ECG changes in a NSTEMI / unstable angina? (2 things)

A
  1. ST depression
  2. T wave inversion (deep)
20
Q

What does a pathological Q wave suggest?

A

Deep infarct (late sign)

21
Q

What is the heart area supplied by the Circumflex Artery?

A

Lateral

22
Q

What are the ECG leads for the Circumflex Artery?

A
  1. I
  2. aVL
  3. V5-6
23
Q

What is the heart area supplied by the LAD?

A

Anterior

24
Q

What are the ECG leads for the Anterior (LAD) part of the heart?

A

V1-2

25
Q

What is the heart area supplied by the Circumflex artery?

A

Lateral

26
Q

What are the ECG leads for the Right Coronary Artery? (3 things)

A
  1. II
  2. III
  3. aVF
27
Q

What is the heart area supplied by the RCA?

A

Inferior

28
Q

What are the ECG leads for the Inferior (RCA) part of the heart? (3 things)

A
  1. II
  2. III
  3. aVF
29
Q

What should you look for in a CXR of sus ACS? (3 things)

A
  1. Cardiomegaly
  2. Pulm oedema
  3. Widened mediastinum
30
Q

What bloods should be done for sus ACS? (5 things)

A
  1. FBC
  2. U&Es
  3. Glucose
  4. Lipids
  5. Cardiac Enzymes (troponin)
31
Q

What are you checking for in a FBC of sus ACS?

A

Anaemia

32
Q

When should U&Es be done in sus ACS?

A

Before ACEi + other meds

33
Q

What is seen on an Echo of ACS?

A

Regional wall abnormalities

34
Q

Apart from ACS, what are some other causes of raised troponin? (5 things)

A
  1. Sepsis
  2. Aortic dissection
  3. Myocarditis
  4. Pulmonary embolism
  5. Chronic renal failure
35
Q

What is needed for a diagnosis of ACS? (6 things)

A

Raised troponin + one of the following:

  1. Ischaemia symptoms
  2. ECG: Changes of new ischaemia
  3. ECG: Pathological Q waves
  4. Echo: New loss of myocardium
  5. Echo: Regional wall motion abnormalities
36
Q

What are the treatment options for a STEMI? (2 things)

A
  1. Primary PCI (if available within 2 hrs of presentation)
  2. Thrombolysis (if PCI not available within 2 hrs)
37
Q

What is PCI? (4 things)

A

Percutaneous Coronary Intervention

  1. Catheter into brachial / femoral artery, up to coronary arteries (XR guided)
  2. Inject contrast to identify blockage area
  3. Balloon to widen gap / device to remove or aspirate blockage
  4. Stent inserted
38
Q

What is the treatment for a NSTEMI? (6 things)

A
  1. B - Beta blockers
  2. A - Aspirin (300mg)
  3. T - Ticagrelor (180mg) (antiplatelet)
  4. M - Morphine
  5. A - Anticoagulant (Fondaparinux)
  6. N - Nitrates (GTN)

BATMAN

39
Q

What score determines if a NSTEMI patient needs a PCI?

A

GRACE score

40
Q

What does the GRACE score determine in a NSTEMI patient?

A

6 month risk of death / repeat MI

41
Q

What does the patient have to score in the GRACE score to have a PCI?

A

Medium / high risk (of having repeat MI / death in next 6 months)

42
Q

How do you prevent a second MI from happening MEDICALLY? (6 A’s)

A
  1. Aspirin (75mg once daily)
  2. Another antiplatelet (clopidogrel / ticagrelor)
  3. Atorvastatin (80mg once daily)
  4. ACE Inhibitors (e.g Ramipril 10mg once daily)
  5. Atenolol
  6. Aldosterone antagonist
43
Q

How do you prevent a second MI from happening LIFESTYLE WISE? (5 things)

A
  1. X Smoking
  2. X Alcohol
  3. Mediterranean diet
  4. Cardiac rehab (specific exercises)
  5. Better treatment for other conditions (e.g DM / HTN)
44
Q

What are the complications of an MI? (5 things)

A
  1. D – Death
  2. R – Rupture of heart septum / papillary muscles
  3. E – Edema
  4. A – Arrhythmia / Aneurysm
  5. D – Dressler’s Syndrome

Y4 Acute Care (31 decks)

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