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Cardiology > Acute Coronary Syndrome > Flashcards

Acute Coronary Syndrome Flashcards

1
Q

What does the left coronary artery branch into?

A

Circumflex artery

Left Anterior Descending (LAD) artery

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2
Q

What does the right coronary artery supply?

A

Right atrium
Right ventricle
Inferior aspect of left ventricle
Posterior septal area

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3
Q

What does the circumflex artery supply?

A

Left atrium

Posterior aspect of left ventricle

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4
Q

What does the left anterior descending (LAD) artery supply?

A

Anterior aspect of left ventricle

Anterior aspect of septum

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5
Q

What are the 3 types of acute coronary syndrome?

A

Unstable angina
ST-elevation myocardial infarction (STEMI)
non-ST-elevation myocardial infarction (NSTEMI)

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6
Q

What findings on ECG would indicate a STEMI?

A

ST segment elevation (in leads consistent with the area of ischaemia)
New left bundle-branch-block

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7
Q

How is an NSTEMI diagnosed on ECG?

A

ST depression
T-wave inversion
Pathological Q-wave

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8
Q

What blood test would diagnose an NSTEMI in the absence of ECG changes?

A

Troponins

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9
Q

Typical presentation of acute coronary syndrome?

A 
Central crushing chest pain (+/- radiation to arms/jaw)
Sweating/clamminess
Nausea/vomiting
Feelings of impending doom
Palpitations
SOB
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10
Q

How long should symptoms continue at rest for to be ACS?

A

20 minutes

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11
Q

How might the presentation of a diabetic patient suffering from ACS differ?

A

They are likely to have fewer symptoms (silent MI).

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12
Q

Which ECG leads represent the left coronary artery?

A

I
aVL
V3-V6

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13
Q

What aspect of the heart does the left coronary artery supply?

A

Anterolateral

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14
Q

Which ECG leads represent the left anterior descending (LAD) artery?

A

V1-V4

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15
Q

Which ECG leads represent the circumflex artery?

A

I
avL
V5-V6

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16
Q

Which ECG leads represent the right coronary artery?

A

II
III
aVL

17
Q

What aspect of the heart does the left anterior descending (LAD) artery supply?

A

Anterior

18
Q

What aspect of the heart does the circumflex artery supply?

A

Lateral

19
Q

What aspect of the heart does the right coronary artery supply?

A

Inferior

20
Q

What are the causes of raised troponin?

A 
MI
Chronic renal failure
Sepsis
Myocarditis
Aortic dissection
Pulmonary embolism
21
Q

In suspected ACS, all the investigations that are performed in suspected stable angina are performed. Which further investigations should also be performed?

A

Chest X-ray
Echocardiogram (after event to assess damage)
CT coronary angiogram

22
Q

What is the management of acute STEMI (within 12 hours of onset)?

A 
Primary PCI (if available within 2 hours of presentation)
Thrombolysis (if PCI is not available within 2 hours)
23
Q

What is the main risk of thrombolysis?

A

Bleeding

24
Q

What are some examples of thrombinolytics?

A

Streptokinase
Alteplase
Tenecteplase

25
Q

What is the management of acute NSTEMI?

A

Oxygen (if required)

Beta blockers
Aspirin (300mg stat)
Ticagrelol (180mg stat) /clopidogrel (300mg)

Morphine
Anticoagulant (LMWH at treatment dose)
Nitrates (GTN)

O BATMAN

26
Q

What is the Grace score?

A

6-month risk of death/repeat MI.

Low risk = <5%
Medium risk = 5-10%
High risk = >10%

This is used to assess for PCI procedures in an NSTEMI

27
Q

How is the Grace score used?

A

Medium/high risk are considered for early (within 4 days of admission) intervention with PCI

28
Q

What are the complications of an MI?

A 
Death
Rupture of heart septum or papillary muscles
Edema 
Arrhythmia/aneurysm
Dressler's syndrome
29
Q

What is Dressler’s syndrome?

A

Post-myocardial infarction syndrome
2-3 weeks post MI
Localised immune response causes pericarditis

30
Q

How does Dressler’s syndrome present?

A

Pleuritic chest pain
low grade fever
pericardial rub

Can result in a pericardial effusion or tamponade

31
Q

How do you investigate for Dressler’s syndrome?

A

ECG - ST elevation and T-wave inversion
Echocardiogram - pericardial effusion
CRP & ESR - may be raised

32
Q

What is the management of Dressler’s syndrome?

A

1st line: NSAIDs
2nd line: Steroids
3rd line: Pericardiocentesis

33
Q

What is the medical secondary prevention following an MI?

A 
Aspirin 75mg
Anti-platelet (clopidogrel)
Atorvastatin 80mg
ACE inhibitor
Atenolol
Aldosterone antagonist (for patients with heart failure)
34
Q

What is the lifestyle secondary prevention following an MI?

A 
Stopping smoking
Reducing alcohol intake
Mediterranean diet
Cardiac rehabilitation
Optimising medical treatment for other medical conditions
35
Q

What is a type 1 MI?

A

Traditional MIs due to an acute coronary event

36
Q

What is a type 2 MI?

A

Ischaemia secondary to increase demand or reduced oxygen supply (e.g. severe anaemia, tachycardia or hypotension)

37
Q

What is a type 3 MI?

A

Sudden cardiac death or cardiac arrest suggesting an ischaemic event

38
Q

What is a type 4 MI?

A

MI associated with procedures (e.g. PCI or CABG)

Cardiology (10 decks)

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