Acute Coronary Syndrome and Acute Myocardial Infarction Presentation and Investigation Flashcards Preview

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Flashcards in Acute Coronary Syndrome and Acute Myocardial Infarction Presentation and Investigation Deck (33)
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1

What is an acute coronary syndrome?

Any sudden cardiac even suspected or proven to be related to a problem with the coronary arteries

2

What is myocardial infarction?

Coronary cell death due to ischaemia

3

What are the causes of myocardial infarction?

Complete coronary artery occlusion
Partial or transient complete coronary artery occlusion

4

What are the causes of MI not related to coronary atherosclerosis?

Coronary vasospasm
Coronary dissection
Embolism of material down a coronary artery
Inflammation of coronary arteries
Radiotherapy to the chest causing fibrosis and stenosis of coronary arteries

5

What are some causes of coronary vasospasm?

Cocaine
Triptans
5-FU chemotherapy

6

What artery is affected in an inferior MI?

Right coronary artery

7

What artery is affected in an anterior MI?

Left anterior descending coronary artery

8

What artery is affected in a lateral MI?

Circumflex coronary artery

9

What can a posterior MI be easily missed?

As there are no ECG leads on the posterior chest

10

Why are some inferior changes also seen in a posterior MI?

As posterior wall is usually supplied by the right coronary artery

11

What is a STEMI caused by?

A completely occluded artery

12

What does a STEMI cause?

Outgoing myocyte death

13

What needs to be done ASAP in a STEMI?

Coronary artery needs to be opened with reperfusion therapy, mechanically in cath lab or pharmacologically

14

What is the difference in patients affected by NSTEMI compared to STEMI?

Patients with NSTEMI tend to be older, more likely to have had a previous MI and are more likely to have had previous CABG or PCI

15

What is the common pathogenesis of NSTEMI?

Atherosclerotic plaque rupture or erosion
Superimposed platelet aggregation and thrombosis
Vasospasm and vasoconstriction
Subtotal or transient total occlusion of vessel

16

What are the risk factors of MI?

Male
Age
Known heart disease
Hypertension
Hypercholesterolaemia
Diabetes
Smoking
FH of premature heart disease

17

What is the typical clinical presentation of an MI?

Chest pain - central crushing/heavy
May radiate to neck/arm/jaw
Often described as discomfort more than pain
May be associated with nausea, sweating and breathlessness

18

What will the initial ECG of a complete coronary artery occlusion show?
What will the ECG show at 3 days?

ST elevation

Will show Q waves at 3 days

May also show hyper-acute T waves

19

What changes will be seen on the ECG of a partial coronary artery occlusion?

Initial ECG will show no ST elevation and no Q waves at 3 days

May show ST segment depression or T wave inversion on the initial ECG

May be normal

20

What is the difference between a STEMI Q wave MI and a NSTEMI non-Q wave MI?

STEMI Q wave MI is transmural
Non-Q wave MI is subendocardial

21

How is an MI diagnoses?

Detection of cardiac cell death through positive cardiac biochemicals (troponin) and one of;
Symptoms of ischaemia
New ECG changes
Evidence of coronary problem on coronary angiogram or autopsy
Evidence of new cardiac damage on another test

22

What are some non-cardiac causes of troponin rise?

Pulmonary embolism
Sepsis
Renal failure
Sub-arachnoid haemorrhage

23

What agents are given as a bolus in thrombolysis?

Tenecteplase
Alteplase and streptokinase are older agents

24

When is thrombolysis contraindicated?

Recent stroke or previous intracranial bleed

25

When is caution needed in thrombolysis?

Recent surgery
Warfarin treatment
Severe hypertension

26

What are the advantages and disadvantages of thrombolysis?

Works if given very early
More likely to cause bleeding problems
May not work, especially in delayed presentation

27

When should patients be referred to the cath lab?

If they can get there within 2 hours of STEMI

28

What is the general management of a suspected acute coronary syndrome?

Admission to hospital
Cardiac monitor
O2 if levels are low

29

What investigations should be done in suspected acute coronary syndrome?

Serial ECGs, consider posterior leads
Blood tests
Check for anaemia
Kidney function tests
Cholesterol levels
Thyroid hormone levels

30

What drugs can be given for chest pain in a suspected acute coronary syndrome?

GTN
Opiates