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(RES) Cardiology > Acute Coronary Syndrome > Flashcards

Acute Coronary Syndrome Flashcards

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1
Q

What is Acute Coronary Syndrome also known as?

A

Coronary artery disease (CAD) or ischemic heart disease (IHD)

Acute Coronary Syndrome encompasses a range of conditions associated with sudden reduced blood flow to the heart.

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1
Q

List the modifiable risk factors for Acute Coronary Syndrome.

A
  • Smoking
  • Physical inactivity
  • Dyslipidemia
  • Hypertension
  • Poor glycemic control

Modifiable risk factors are lifestyle-related and can be altered to reduce the risk of heart disease.

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2
Q

List the non-modifiable risk factors for Acute Coronary Syndrome.

A
  • Age
  • Female gender
  • Family history

Non-modifiable risk factors are inherent and cannot be changed.

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3
Q

What is the common symptom of Acute Coronary Syndrome?

A

Chest pain

Chest pain can vary in intensity and duration and may be accompanied by other symptoms.

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4
Q

What is the underlying mechanism of Acute Coronary Syndrome?

A

Atherosclerosis of coronary arteries

Atherosclerosis involves the buildup of fatty deposits in the artery walls, leading to reduced blood flow.

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5
Q

How often should cardiac enzymes be checked to confirm infarction?

A

At least twice with 6-8 hours apart

Cardiac enzymes are indicators of heart muscle damage and are crucial for diagnosing heart attacks.

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6
Q

What is a key symptom of STEMI?

A

Chest pain more intense than in angina, not fully relieved by rest or nitroglycerin

Other symptoms include nausea, sweating, and in 25% of cases, asymptomatic presentation.

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7
Q

What are common examination findings in STEMI?

A

Tachycardia and jugular vein distention, particularly in case of right ventricular infarction

These findings help in the clinical assessment of STEMI.

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8
Q

What does an ECG show in STEMI?

A

ST elevation, T-wave inversion (if reperfusion is not achieved), and Q wave

These changes are critical for diagnosis.

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9
Q

What biomarkers are important for diagnosing STEMI?

A
  • Troponins (T and I) - highly specific, remains elevated for 7-10 days
  • CK-MB - rises within 4-8 hours but returns to normal in 2-3 days; also elevated in myocarditis and after electrical cardioversion

Troponins are the most specific for myocardial injury.

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10
Q

What are potential complications of STEMI?

A
  • Arrhythmias
  • Heart failure
  • Cardiogenic shock
  • Ventricular aneurysm
  • Recurrent angina

These complications can significantly affect patient outcomes.

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11
Q

What is the immediate treatment for STEMI?

A
  • Aspirin - 300mg immediately
  • Percutaneous coronary intervention (PCI) - most effective therapy
  • IV fibrinolytics (e.g., streptokinase) if PCI is not available
  • Pain control (e.g., morphine, nitroglycerin)
  • Oxygen

These treatments aim to restore blood flow and relieve pain.

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12
Q

What additional treatments are recommended for STEMI?

A
  • β-blockers
  • Anticoagulants (e.g., UFH 5000 units)
  • Antiplatelets (e.g., clopidogrel 600mg)

These medications help in managing the patient’s condition post-STEMI.

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13
Q

What is the treatment for heart failure in the context of STEMI?

A
  • ACE inhibitors
  • ARBs
  • Aldosterone antagonists

These medications are critical for managing heart failure following STEMI.

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14
Q

STEMI

Location of MI
-Anterior Wall-
Name Leads affected

A

V2 to V4

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15
Q

STEMI

Location of MI
-Anterior Wall-
Vessel involved

A
  • Left Anterior descending artery (LAD)
  • Diagonal Branch
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16
Q

STEMI

Location of MI
-Anterior Wall-
ECG changes:

A
  • Poor R-wave progression
  • ST-segment elevation
  • T-Wave inversion
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17
Q

STEMI

Location of MI
-Septal wall-
Leads affected:

A

V1
V2

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18
Q

STEMI

Location of MI
-Septal wall-
Vessel involved

A
  • Left Anterior Descending artery (LAD)
  • Septal Branch
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19
Q

STEMI

Location of MI
-Septal wall-
ECG changes:

A
  • R wave disappears
  • ST segment rises
  • T wave inverts
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20
Q

STEMI

Location of MI
-Lateral Wall-
Leads Affected:

A

1
aVL
V5
V6

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21
Q

STEMI

Location of MI
-Lateral Wall-
Vessel Involved:

A
  • Left Coronary ARtery (LCA)
  • Circumflex Branch
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22
Q

STEMI

Location of MI
-Lateral Wall-
ECG Changes:

A

ST Segment elevation

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23
Q

STEMI

Location of MI
-Inferior Wall-
Leads affected:

A

II
III
aVF

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24
# STEMI Location of MI -Inferior Wall- Vessels involved:
- Right coronary artery (RCA) - Posterior descending branch
25
# STEMI Location of MI -Inferior Wall- ECG changes:
- T Wave inversion - ST segment elevation
26
# STEMI Location of MI -Posterior wall- Leads affected:
V1 to V4
27
# STEMI Location of MI -Posterior wall- Vessel involved:
- Left coronary artery (LCA) -Circumflex branch - Right coronary artery (RCA) -Posterior Descending branch
28
What does NSTEMI stand for?
Non-ST-Elevation Myocardial Infarction ## Footnote NSTEMI is a type of heart attack that is characterized by specific clinical features and diagnostic markers.
29
How is NSTEMI similar to unstable angina?
Both conditions present with chest pain and may have similar symptoms. ## Footnote Unstable angina is a condition where the heart does not receive enough blood flow, leading to chest pain, but without myocardial necrosis.
30
What is a key difference between NSTEMI and unstable angina?
NSTEMI shows evidence of myocardial necrosis indicated by increased cardiac markers. ## Footnote Cardiac markers such as troponin are elevated in NSTEMI, confirming damage to heart tissue.
31
What symptoms can some patients with NSTEMI experience?
Symptoms identical to STEMI, such as severe chest pain. ## Footnote STEMI, or ST-Elevation Myocardial Infarction, typically shows more pronounced ECG changes.
32
What distinguishes the ECG findings of NSTEMI from STEMI?
NSTEMI has different ECG findings compared to STEMI. ## Footnote The main difference is that STEMI shows ST-segment elevation on the ECG, while NSTEMI does not.
33
Fill in the blank: NSTEMI is characterized by evidence of myocardial necrosis, indicated by _______.
increased cardiac markers
34
# NSTEMI What is dual anti-platelet therapy (DAPT)?
A treatment regimen involving the use of two antiplatelet medications
35
# NSTEMI What medications are commonly used in DAPT after an MI?
Aspirin 75mg + clopidogrel 75mg (or prasugrel or ticagrel)
36
# NSTEMI How long should DAPT be continued after an MI?
For 2 months
37
# NSTEMI What is the long-term treatment following DAPT for patients who have had an MI?
Aspirin for life
38
# NSTEMI Fill in the blank: DAPT involves aspirin 75mg + _______ for 2 months after an MI.
clopidogrel 75mg (or prasugrel or ticagrel)
39
# NSTEMI What is a key clinical picture of unstable angina?
New onset of severe angina ## Footnote Includes angina at rest or with minimal activity, and recent increase in frequency and intensity of chronic angina.
40
# NSTEMI What symptoms are associated with unstable angina?
Chest pain, sweating ## Footnote These symptoms can help in the clinical assessment of unstable angina.
41
# NSTEMI What are common examination findings in unstable angina?
Tachycardia, ST depression, T-wave inversion ## Footnote ST depression suggests ischemia and these findings may not always be present.
42
# NSTEMI What do negative cardiac biomarkers indicate after 6-8 hours?
They suggest that myocardial infarction is less likely ## Footnote Negative biomarkers are typically expected in unstable angina.
43
# NSTEMI What are the anti-thrombotic treatments for unstable angina?
Aspirin, clopidogrel, UFH, LMWH (e.g., enoxaparin) ## Footnote These medications help prevent further clot formation.
44
# NSTEMI What anti-ischemic treatments are used for unstable angina?
Nitroglycerin, beta blockers, verapamil, diltiazem ## Footnote Verapamil or diltiazem are used if beta blockers are contraindicated.
45
# NSTEMI What role does morphine play in the treatment of unstable angina?
Pain relief ## Footnote Morphine is used to manage severe chest pain.
46
# NSTEMI What invasive strategies may be considered for high-risk patients with unstable angina?
PCI, CABG ## Footnote High-risk patients may include those with recurrent angina at rest, NSTEMI, ST depression, diabetes, or renal dysfunction.
47
# NSTEMI What are some long-term management strategies for unstable angina?
Lifestyle modifications, aspirin, clopidogrel, beta blocker, ACEi, ARB ## Footnote These strategies aim to reduce future cardiovascular events.
48
# NSTEMI What is the most common cause of chronic stable angina?
Atherosclerotic coronary artery obstruction ## Footnote This condition involves the narrowing of coronary arteries due to plaque buildup.
49
# NSTEMI What are some other causes of chronic stable angina?
* Aortic valve disease * Hypertrophic cardiomyopathy * Coronary artery spasm ## Footnote These conditions can also lead to reduced blood flow to the heart muscle.
50
# NSTEMI What is a common symptom of chronic stable angina?
Chest pain on exertion or stress, relieved by rest or nitroglycerin ## Footnote This pain is typically triggered by physical activity or emotional stress.
51
# NSTEMI What are the typical examination findings for chronic stable angina?
Often normal ## Footnote Physical exams may not show abnormalities unless an episode is occurring.
52
# NSTEMI What ECG findings may occur during angina episodes?
Transient ST and T wave abnormalities ## Footnote These changes are indicative of ischemia during episodes of angina.
53
# NSTEMI What diagnostic test helps in diagnosing coronary artery disease (CAD)?
Stress test ## Footnote This test evaluates the heart's performance under stress conditions.
54
# NSTEMI What is the definitive test for assessing CAD severity?
Coronary arteriography ## Footnote This invasive procedure visualizes the coronary arteries.
55
# NSTEMI What is an important aspect of treating chronic stable angina?
Identify and treat risk factors ## Footnote This includes addressing smoking cessation, diabetes, hypertension, and lipid disorders.
56
# NSTEMI What are some exacerbating factors for chronic stable angina?
* Obesity * Congestive heart failure * Anemia * Hyperthyroidism ## Footnote These conditions can worsen angina symptoms.
57
# NSTEMI What is the role of nitroglycerin in the treatment of chronic stable angina?
Immediate relief and prophylactic use before activity ## Footnote Nitroglycerin acts as a vasodilator to relieve chest pain.
58
# NSTEMI What medications are used for long-term suppression of chronic stable angina?
* Long-acting nitrates * Beta blockers * Sustained-release CCBs * Ranolazine (if others don't work) ## Footnote These medications help manage chronic symptoms and improve quality of life.
59
# NSTEMI What is the role of aspirin in the management of chronic stable angina?
Reduces MI incidence ## Footnote Aspirin is used for its antiplatelet effects to prevent heart attacks.
60
# NSTEMI What mechanical revascularization procedures may be considered for chronic stable angina?
* PCI * CABG ## Footnote These procedures are typically used when medications are ineffective or intolerable.
61
# NSTEMI What is Prinzmetal’s variant angina?
Intermittent focal spasm of coronary artery
62
# NSTEMI What serious conditions may develop during a spasm in Prinzmetal’s variant angina?
Acute infarction or malignant arrhythmias
63
# NSTEMI What are the symptoms of Prinzmetal’s variant angina?
Chest pain more severe than in angina, typically occurs at rest
64
# NSTEMI What is the treatment for Prinzmetal’s variant angina?
Long-acting nitrates, CCBs
65
Name NSTEMI
- Unstable angina - Chronic stable angina - Prinzmetal’s variant angina

(RES) Cardiology (23 decks)

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