acute coronary syndrome (ACS)

Question 1

angina presentation

Answer 1

substernal type of chest pain radiating to the neck, face and left arm

Question 2

angina cause

Answer 2

insufficient oxygen supply to the heart muscle leading to ischaemia often due to atherosclerotic plaque build-up in coronary arteries

Question 3

decreased oxygen supply consequences (2)

Answer 3

decreased perfusion pressure and decreased arterial oxygen content

Question 4

increased oxygen demand consequences (4)

Answer 4

increased heart rate, increased preload, increased afterload, increased contractility

Question 5

coronary artery diseases

Answer 5

diseases affecting the heart and coronary blood vessels often due to atherosclerosis and hypertension

Question 6

CAD divisions (2)

Answer 6

stable angina and ACS

Question 7

ACS divisions

Answer 7

unstable angina, NSTEMI, STEMI

Question 8

stable angina pathology

Answer 8

stable fixed plaque covered by fibrous tissue

Question 9

unstable angina pathology

Answer 9

plaque rupture and platelet aggregation

Question 10

non-ST segment elevation myocardial infarction (NSTEMI) pathology

Answer 10

partial or incomplete blockage of coronary artery with plaque rupture

Question 11

ST segment elevation myocardial infarction (STEMI) pathology

Answer 11

complete blockage of coronary artery often due to other precipitant with plaque rupture

Question 12

CAD risks (6)

Answer 12

smoking, advanced age, diabetes, cholesterol, hypertension, family history

Question 13

CAD symptoms (4)

Answer 13

angina, epigastric abdominal pain, nausea, diaphoresis

Question 14

CAD diagnosis

Answer 14

12 lead ECG and cardiac biomarker test (troponins, CK-MB)

Question 15

stable angina diagnosis

Answer 15

normal ECG during rest and T-wave inversion and/or ST depression during stress and negative troponin; obtain coronary angiogram for localising lesion

Question 16

stable angina first line of treatment (5)

Answer 16

aspirin, beta blockers, calcium channel blockers, GTN, statins

Question 17

stable angina second line of treatment

Answer 17

revascularisation

Question 18

when to give second line of treatment for stable angina (3)

Answer 18

positive stress test, high risk lesions, ineffective therapy

Question 19

revascularisation therapies

Answer 19

PCI/CABG and dual anti-platelet for a year

Question 20

coronary angioplasty or PCI

Answer 20

catheter inserts balloon or stent to widen coronary artery (not used for LCA occlusion)

Question 21

coronary artery bypass graft (CABG)

Answer 21

uses graft from other vessels to bypass lesion

Question 22

unstable angina diagnosis

Answer 22

T-wave inversion and/or ST depression and negative troponin

Question 23

NSTEMI diagnosis

Answer 23

T-wave inversion and/or ST depression and positive troponin

Question 24

unstable angina or NSTEMI first line of treatment (6)

Answer 24

BATMAN = beta blockers, aspirin, dual anti-platelet therapy (+ heparin), morphine, statins, GTN

Question 25

unstable angina or NSTEMI second line of treatment

Answer 25

revascularisation

Question 26

when to give second line of treatment for unstable angina or NSTEMI (4)

Answer 26

TIMI score>3, cardiogenic shock, ventricular fibrillation, ineffective therapy

Question 27

STEMI diagnosis

Answer 27

ST-segment elevation and positive troponin

Question 28

vasospastic angina diagnosis

Answer 28

ST-segment elevation and negative troponin

Question 29

STEMI first line of treatment

Answer 29

MONA = morphine, oxygen, GTN, aspirin; revascularisation (primary PCI or thrombolysis), ACE-Is, beta blockers, dual anti-platelet therapy, GTN, statins

Question 30

reasons for using primary PCI

Answer 30

within 12 hours of symptom onset and will achieve repercussion within 90 mins arrival to ED; for patients meeting ECG criteria for urgent reperfusion

Question 31

reasons for using thrombolysis

Answer 31

6-12 hours of symptom onset and will achieve repercussion within 90 mins arrival to ED if primary PCI is unavailable

Question 32

STEMI second line of treatment (6)

Answer 32

ACE-Is, aldosterone antagonists, aspirin and another anti-platelet, atenolol, atorvastatin

Question 33

non-pharmacological secondary preventions

Answer 33

limited alcohol, diabetes and hypertension control, diet and weight modifications, increased exercise, smoking cessation

Question 34

primary PCI benefits

Answer 34

faster as does not administer fibrinolytic agents or GPIIb/IIIa inhibitors

Question 35

rescue PCI

Answer 35

used if thrombolysis is not successful

Question 36

pharmaco-invasive PCI

Answer 36

used 3-24 hours after thrombolysis

Question 37

late pCI

Answer 37

used 12-24 hours in patients with ongoing ischaemia

Question 38

myocardial infarction complications (4)

Answer 38

arrhythmia, acute heart failure, pericarditis, rupture syndrome

Question 39

arrhythmia complications (3)

Answer 39

bradycardia, ventricular tachycardia, sudden cardiac death

Question 40

acute heart failure complications (2)

Answer 40

multi-system organ failure and hypoxia or dyspnea

Question 41

pericarditis complications

Answer 41

pleuritic chest pain and/or friction rub

Question 42

rupture syndrome complications (3)

Answer 42

heart failure, cardiac tamponade, stroke