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Cardio > Acute Coronary Syndrome > Flashcards

Acute Coronary Syndrome Flashcards

1
Q

what is ACS?

A

an atherosclerotic plaque that becomes a thrombus and blocks and artery

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2
Q

what is a thrombus in a fast flowing artery usually made up of?

A

platelets

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3
Q

what are the types of ACS?

A

unstable angina
none ST elevation MI (NSTEMI)
ST elevation MI (STEMI)

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4
Q

what does the aorta branch into?

A

the left ad right coronary arteries

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5
Q

what does the left coroanry artey become?

A

circumflex artery
left anterior descending

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6
Q

where is the circumflex artery?

A

it curves around the top, left and back of the heart

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7
Q

what does the circumflex artery supply?

A

the left atrium
the posterior aspect of the left ventricle

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8
Q

where is the LAD?

A

it travels down the middle of the heart

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9
Q

what does the LAD? supply?

A

the anterior left ventricle
anterior septum

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10
Q

what does the right coronary artery supply?

A

the right atrium
the right ventricle
the inferior left ventricle
posterior septal area

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11
Q

how would a patint with ACS present?

A

usually central constricitn chest pin, assoc w
radiatio to jaw or arm
nausea and vomiting
shortness of breath
sense of impending doom
sweats and claminess
palpitations

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12
Q

what is a silent MI?

A

when a patient has no typical chest pain during ACS

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13
Q

who is more at risk of a silent MI?

A

diabetics

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14
Q

how long should symptoms continue to likely be ACS?

A

at rest for mor than 15 minutes

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15
Q

what ECD chnages are see i an NSTEMI?

A

ST depression
T wave inversion

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16
Q

what ECG changes are seen in a STEMI?

A

ST elevation
new left buncdle branch block

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17
Q

what do pahtologicla Q waves suggest?

A

deep, transmura iinfarction
usually 6+ hours after inset of symptoms

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18
Q

what area of the heart is affected by each artery?

A

LCA - anterolateral
LAD - anterior
RCA inferior
circumflex - lateral

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19
Q

which ECG leads are affected by each artery?

A

LCA - I, aVL, v3-6
LAD- V1-4
RCA - II, III, aVF
circumflex - I, aVL, V5-6

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20
Q

what is troponin?

A

a protein in the myocardium and skeletal muscle

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21
Q

what is a rise in troponin assoc w and why?

A

myocardial ischaemia
as is released from ischael muscle tissue

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22
Q

what are troponin results used to diagnose?

A

NSTEMI
not STEMI (use ECG and clinical presentation)

23
Q

in case of suspected ACS what troponin results indicate an NSTEMI?

A

high
or rising on repeated tests

24
Q

why is troponin a non specific marker?

A

rise in troponin can also be caused by:
- chronic kidney disease
- pulmonary embolism
- aortic dissection
- myocarditis
- sepsis

25
Q

what other investigations apart from ECG and troponin are done for suspected/cofirmed ACS?

A

baseline bloods - full blood count, urea and electrolytes, liver function test, lipids and glucose
chest x-ray - look for pulmonary oedema and any there causes of chest pain
echocardiogram - to check function damage to heart esp left ventricular function

26
Q

what diagnoses a STEMI?

A

ST elevation
or
new left bundle branch block

27
Q

what diagnoses and NSTEMI?

A

raised troponin with either
- normal ECG
- other ECG changes (not ST elevation) i.e ST depression or T wave inversion

28
Q

what diagnoses unstable angina?

A

normal troponin with normal ECG or ECG changes that aren’t ST elevation

29
Q

what would a patient with chest pain, normal ECG and normal troponin be diagnosed with?

A

either unstable angina or another cause of pain such as musculoskeletal pain

30
Q

what is the initial management for ACS?

A

Call ambulance
Perform ECG
Aspirin 300mg
IV morphine (pain if needed) w antiemetic (metoclopramide)
Nitrate (GTN)

31
Q

what should happen to a patient who is pain free but hs had constricting central chest pain in the last 72hrs?

A

should be admitted to hospital for same day assessment
usually seen in ambulatory care unit
may need emergency admission if ECG changes or complications - HF

32
Q

what are the two management options for a STEMI and when is each used?

A

PCI - if available within 2hrs of presnting
thrombolysis - if PCI not available within 2hrs

33
Q

what is a PCI?

A

PERCUTANEOUS CORONARY INTERVENTION
angiography
angioplasty or devices to remove/aspirate blockage
stent usually inserted to keep artery open

34
Q

what is an angiography?

A

catheter is put into the radial or femoral artery - radial preferred
fed through using x-ray
contrast injected to identify blockage

35
Q

what is an angioplasty?

A

balloons being used to widen lumen to treat a blockage

36
Q

what medications may be advised before a PCI?

A

aspirin or prasugrel

37
Q

what is thrombolysis?

A

injecting a fibrinolytic agent

38
Q

what do fibrinolytic/thrombllytic agents do?

A

break down fibrin in blood clots

39
Q

what makes thrombolysis dangerous?

A

significant bleeding risk

40
Q

give examples of thrombolytic agents

A

streptokinase
alteplase
tenecteplase

41
Q

what is the management of NSTEMI?

A

Base decision on angiogrpah/PCI on GRACE score
Aspirin 300mg stat dose
Ticagrelor 180mh stat dose
Morpgine titrated for pai
Antithrombin therapy with fondaparinux
Nitrate (GTN)

42
Q

what would be used instead of ticagrelor if a patient with an NSTEMI has a high bleeding risk?

A

clopidogrel

43
Q

what would be used instead of ticagrelor is a patient with an NSTEMI is getting an angiography?

A

prasugrel

44
Q

when would a patient with an NSTEMI not be given fondaparinux as an antithrombin?

A

when they have a high bleeding risk or are getting an immediate angiography

45
Q

what are unstable NSTEMI patients considered for?

A

an immediate angiography

46
Q

what does the GRACE score measure?

A

the 6 month probability of death after an NSTEMI

47
Q

what GRACE scores give what level of risk?

A

3% or less = low risk
greater than 3% = medium to high risk

48
Q

what are patients with a medium-rhigh risk calculated by the GRACE score considered for?

A

an early angiography with PCI within 72hrs

49
Q

what is the ongoing management of ACS?

A

once stable, an echocardiogram to asses function, especially left ventricular function
cardiac rehabilitation
secondary prevention

50
Q

what is secondary prevention after an MI?

A

Aspirin 75mg once daily, indefinitely
Another anti platelet for 12months (usually clopidogrel or ticagrelor)
Atorvastatin 80mg once daily
ACEi titrated as high as tolerated (ramipril)
Atenolol (or other beta blocker - bisprolol) titrated as high as tolerated
Aldosterone antagonist for patients with clinical HF, eplerenone titrated to 5omg once daily

51
Q

why can dual antiplatelet therapy vary after PCI?

A

depends on the stent used

52
Q

what is important to monitor in patients taking ACEi and aldosterone antagonists and why?

A

renal function
can cause hyperkalaemia

53
Q

what drug combination carries a risk o fatal hyperkalaemia?

A

spironolactone or epelerenone (aldosterone antagonists)
+
ACEi or ARB

54
Q

what are the complications of a MI?

A

Death
Rupture of heart septum or papillary muscles
E oEdema - heart failure
Arrhythmia or aneurysm
Dressler’s syndrome

Cardio (4 decks)

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