[acute coronary syndrome]+[STEMI Mx] Flashcards
(91 cards)
1
Q
A
STEMI
NSTEMI
unstable angina
2
Q
A
STEMI
3
Q
A
disruption of vulnerable/high risk plaque
leading to platelet activation–> thrombus
disrupted blood flow/occlusion
ischaemia
(can be due to vasculitides/spasm)
4
Q
A
increased perspiration
5
Q
A
1st degree relative
6
Q
A
relaxed
unaffected by winning/losing
etc.
7
Q
A
ambitious sensitive stressed workaholic etc
8
Q
A
modifiable
non-modifiable
controversial
9
Q
A
increasing age
male gender
family Hx of IHS (see criteria)
10
Q
A
cocaine
11
Q
A
DM hypertension hyperlipidaemia obesity sedentary lifestyle smoking cocaine use
12
Q
A
ACE
angiotensin converting enzyme
13
Q
A
DD-ACE
14
Q
A
CK-MB ( CK cardiac isoenzyme)
AST (aspartate transaminase)
LDH (Lactate dehydrogenase)
Trop (Cardiac troponin)
15
Q
A
CK-BB (CK brain)
CK-MM (skeletal muscle- up post trauma/exercise/myositis/hypothyroid/afrocaribs)
CK-MB (cardiac )
16
Q
A
3-12 hours
17
Q
A
within 24 hours
18
Q
A
48-72 hours
19
Q
A
afro-caribbean
20
Q
A
aortic dissection GO reflux pericarditis myocarditis PE angina
21
Q
A
3
22
Q
A
I
T
23
Q
A
Muscle contraction from cardiac or skeletal muscle (NOT SMOOTH MUSCLE)
24
Q
A
troponin I
troponin t
25
[ACS]: after the onset of chest pain when do troponin levels start to rise
3-12 hours
26
[ACS]: after the onset of chest pain when do troponin levels peak
24-48 hours
27
[ACS]: after the onset of chest pain when do troponin levels return to baselines
5-14 days
28
[ACS]: why are myoglobin levels of limited use
very unspecific
29
[ACS]: increased fibrinogen and hyperinsulinaemia are what category of risk factor
controversial
30
[ACS]: how is ACS diagnosed (5)
an increase followed by decrease in cardiac biomarkers
+ one of:
symptoms of ischaemia
ECG changes of new ischaemia
pathological Q waves
loss of myocardium on imaging
31
[ACS]: what do pathological q waves indicate
previous MI
32
[ACS]: Dx is made by a increase then decrease in cardiac biomarkers plus one of ... (4)
symptoms of ischaemia
ECG changes of new ischaemia
pathological Q waves
loss of myocardium on imaging
33
[ACS]: which two groups may be at increased risk of presenting with silent MIs
the elderly
| diabetics
34
[ACS]: what are the 2 classical cardiac related symptoms of ACS
acute chest pain (>20 mins)
| palpitations
35
[ACS]: how long does the chest pain typically last
20 minutes
36
[ACS]: what symptoms may present in a silent MI (8)
```
epigastric pain
vomiting
syncope
pulmonary oedema
stroke
confusion
DM hyperglycaemic states
post-operative hypotension
```
37
[ACS]: what will the pulse and BP
high OR low!
38
[ACS]: what 6 signs may be present during ACS
```
raised JVP
anxiety
pallor
sweatiness
low grade fever
pulmonary oedema
```
39
[ACS]: in what % will the initial ECG be normal
20%
40
[ACS]: what respiratory related symptom may be present
dyspnoea
41
[ACS]: what 2 non system specific symptoms may be present
perspiration
| nausea
42
[ACS]: what cardiac related signs may be present (2)
raised JVP
| pulmonary oedema
43
[ACS]: if troponin levels are not raised ... hours post chest pain AND the ECG is normal the risk of missing an MI is tiny (less than 0.3%)
6 hours
44
[ACS]: what are the 2 isoenzyme of LDH (2)
LDH-1 (found in the heart)
| LDH-2 (found in the serum)
45
[ACS]: what indicates an MI in relation to the LDH
a high LDH-1:LDH-2 ratio
46
[ACS]: Ix: what 2 investigations will you order? (2)
ECG
| CXR
47
[ACS]: Ix: what changes on ECG would you see in STEMI hours after the event (3)
hyperacute T waves
| ST elevation or LBBB
48
[ACS]: Ix: what changes on ECG would you see days after the event (2)
inverted T waves
| pathological Q waves
49
[ACS]: Ix: what are the criteria for a pathological Q wave (1)
>25% of the depth of the QRS complex
50
[ACS]: Ix: does a normal ECG at the onset of pain exclude MI
no 20% are normal initially
51
[ACS]: Ix: on CXR how would an aortic dissection present
widened mediastinum
52
[ACS]: Ix: what 3 things will you look for on CXR
widened mediastinum
pulmonary oedema
cardiomegaly
53
[ACS]: when can a patient be discharged (3)
symptoms settle
no ST elevation
no rise in troponin after 6 hours
54
[ACS]: Mx: Pre-hospital (i.e. outside of hospital either NSTEMI/STEMI) what will your 1st step be?
call an ambulance
55
[ACS]: Mx: what 4 drugs are given pre-hospital (i.e. before identification of NSTEMI/STEMI) (4)
```
aspirin 300mg chewed (if no absolute CIs)
+
GTN (sublingual) (not in STEMI)
+
morphine 5-10mg IV
+
metoclopramide 10mg IV
```
56
[ACS]: Mx: what are the absolute CIs for aspirin (5)
```
bleeding disorder (haemophilia/vWF)
recent GI/intracranial bleed
salicylate allergy
Renal failure
liver failure
```
57
[ACS]: Mx: why are the pre-hospital drugs given IV and never IM
increased risk of bleeding due to thrombolysis
58
[ACS]: what the proper name for what is commonly referred to as an acute MI?
STEMI
59
[ACS]: Mx: STEMI: what 3 thing will you do 'before' any drug adminstration?
12 lead ECG initiated
IV access
assessment
60
[ACS]: Mx: STEMI: why is it important to attach an ECG asap
STEMI/NSTEMI determines treatment pathway
61
[ACS]: Mx: STEMI: why is it important to gain IV access
Blood tests
| IV drug administration
62
[ACS]: Mx: STEMI: which blood tests will you carry out (5)
```
FBC
U+Es
Cardiac enzymes (troponin IT)
lipids
glucose
```
63
[ACS]: Mx: STEMI: what 3 things are included in your brief assessment of the patient (3)
Risk factor assessment for CVD/IHD (inc. familyHx)
Examination
CIs to PCI or fibrinolysis
64
[ACS]: Mx: STEMI: what are the 3 drugs given in STEMI acute Mx
```
aspirin 300mg PO
+
morphine 5-10mg IV
+
metoclopramide 10mg IV
```
65
[ACS]: Mx: STEMI: below what O2 sat will you give O2
less than 95%
66
[ACS]: Mx: STEMI: in what heart condition will you give O2
left ventricular failure
67
[ACS]: Mx: STEMI: when would you give GTN sublingual in STEMI Mx (2)
hypertensive
| acute LVF
68
[ACS]: Mx: STEMI: if the patient is in STEMI + acute LVF what 2 drugs would you add in to the Mx plan
O2
| GTN
69
[ACS]: Mx: STEMI: the initial drug treatments are aimed at preventing further damage until reperfusion can be achieved; in what 2 ways can this be achieved? (2)
PCI (+bivalirudin) (percutaneous coronary intervention - angioplasty)
thrombolysis
70
[ACS]: Mx: STEMI: do you give pain management before or after aspirin?
before - allows for easier Hx taking - vital!
71
[ACS]: Mx: STEMI: describe PCI (+bivalirudin) procedure
coronary angioplasty - balloon inserted and inflated
72
[ACS]: Mx: STEMI: PCI (+bivalirudin) is only the indicated Tx in what circumstance
patients can be at a primary PCI (+bivalirudin) centre within 120 minutes of FIRST MEDICAL CONTACT (paramedic/GP/morphine)
73
[ACS]: Mx: STEMI: if patients will take too long to reach the PCI centre what Tx is indicated in STEMI
fibrinolysis
74
[ACS]: Mx: STEMI: within what time of onset of chest pain is the target time for thrombolysis
less than 30 minutes
75
[ACS]: Mx: STEMI: 4 ECG changes MUST be present to indicate thrombolysis (i.e. confirmation that this is STEMI) what are they (4)
ST elevation >1mm in 2 or more limb leads
or
ST elevation >2mm in 2 or more chest leads
+
new onset LBBB (i.e. no prior pathology)
+
posterior changes (ST depression+tall R in V1-V3)
76
[ACS]: Mx: STEMI: what are posterior changes
Deep ST depression
| Tall R waves in leads V1, V2 and V3
77
[ACS]: Mx: STEMI: in what time frame is is fibrinolysis CI'd
>24 has passed from onset of chest pain
78
[ACS]: Mx: STEMI: if a patient cannot get to a PCI (+bivalirudin) centre within 120 mins what is the next step
fibrinolysis post ECG confirmation of STEMI
79
[ACS]: Mx: STEMI: if a patient cannot get to a PCI (+bivalirudin) centre within 120 mins, are then thrombolysed and are then transferred to a PCI centre what are the next two options? (2)
PCI (+bivalirudin) if fibrinolysis unsuccessful
| angiography if successful
80
[ACS]: Mx: STEMI: what drug must be administered with primary PCI treatment
bivalirudin
81
[ACS]: Mx: STEMI: what type of drug MUST be administered with primary PCI treatment
DTI (direct thrombin inhibitor)
82
[ACS]: Mx: STEMI: why should all patients be transferred to a primary PCI centre after their treatment?
recurrent ischaemia is common
83
[ACS]: Mx: STEMI: what complication can NSAID use have
pericarditis
84
[ACS]: Mx: STEMI: thrombolysis is CI'd in what broad category of pathologies?
increased risk of bleeding
85
[ACS]: Mx: STEMI: give 3 head related CI's to thrombolysis
```
previous intracranial haemorrhage
ischaemic stroke within 6 months
Cerebral AVM (/malignancy)
```
86
[ACS]: Mx: STEMI: give 2 iatrogenic causes of thrombolysis CI
non-compressible punctures (LP/liver biopsy)
| recent major surgery (/trauma etc)
87
[ACS]: Mx: STEMI: what long standing disease category is a CI for thrombolysis
bleeding disorder
88
[ACS]: Mx: STEMI: ... dissection is a CI for thrombolysis
aortic
89
[ACS]: Mx: STEMI: bleeds from which 2 systems are CI for thrombolysis
GI (within 1 month)
| cranial
90
[ACS]: Mx: STEMI: what drug is 1st line for fibrinolysis
alteplase
91
[ACS]: Mx: STEMI: if a patient has a confirmed STEMI, cannot get to a PCI centre in 120 minutes and is known to have a bleeding disorder (or other CI) what is the Tx?
Fondaparinux
