Acute Coronary Syndromes

Question 1

What three conditions make up ACS?

Answer 1

Unstable Angina, MI, Sudden Cardiac Death

Question 2

What are two types of MI, what is the difference?

Answer 2

STEMI- ST elevated MI- Vbad

NSTEMI- non- ST elevated MI- often less severe.

Question 3

What is the pathophysiology?

Answer 3

Plaque rupture and local thrombosis.

Question 4

What causes plaques to rupture?

Answer 4

• Inflammation
• Flow changes
• Change in the make up of blood
• Stress on the endothelial wall.

Question 5

Risk Factors

Answer 5

-Age, Gender, Previous Angina/MI, Genes, Smoking, Hyperlipidaemia, Hypercholesterolaemia, Hypertension, Diabetes.

Question 6

What to look for in an ECG?

Answer 6

Transient ST elevation
T wave inversion
ST segment depression
-UAP changes will be temporary
-NSTEMI- changes persist at rest

Question 7

What groups may experience atypical symptoms?

Answer 7

Women, Diabetics, Elderly

Question 8

Name atypical symptoms

Answer 8

Breathlessness (heart failure)
Nausea & Vomiting (autonomic symptoms)
Epigastric Pain (recent onset indigestion)

Question 9

What biomarker may be evident?

Answer 9

Cardiac Troponin

• Will be present in the blood after damage to myocardial cells
• Not specific to ACS - just shows damage.

Question 10

Treatment of UAP & NSTEMI

Answer 10

ABCDE- ensure stable
MONA
Dual Antiplatelet therapy for 1 year
Anti-thrombotic therapy- Heparin/ Fondaparinux
B blockers
Statins
ACE- if left ventricular dysfunction

Question 11

What does MONA stand for?

Answer 11

Morphine
Oxygen
Nitrates (GTN)
Aspirin - 300mg

Question 12

Describe Dual Anti-platelet therapy

Answer 12

Aspirin + Clopidogrel

Question 13

Describe anti-thrombotic therapy

Answer 13

Low molecular weight heparin

Fondaparinux

Question 14

What is the target heart rate?

Answer 14

50-60 bpm

Question 15

Surgical intervention?

Answer 15

Coronary Revascularisation

• PCI
• CABG

Question 16

STEMI

Answer 16

More complete/ complete occlusion of Artery

Leads to INFARCTION

Question 17

What key structures could be affected?

Answer 17

• Papillary Muscles

- AV node

Question 18

Aim in treatment of STEMI?

Answer 18

Remove occlusion and restore circulation to Ventricles

Question 19

How to remove an occlusion?

Answer 19

• Primary PCI

- Fibrinolysis

Question 20

When to do primary PCI

Answer 20

• door to balloon <90 mins

- >3hrs symptom onset

Question 21

When to do Fibrinolysis?

Answer 21

• door to balloon = 90 mins
• <3 hrs symptom onset
• Can be done Pre-hospital in remote situations.
• Risk of bleeding and haemorrhage.

Question 22

Prevention of STEMI

Answer 22

ASA + clopidogrel
Beta Blocker
Statins (lower LDL <3.2mmol/l)
ACE Inhibitor (in LV dysfunction)

Question 23

What two things may determine survival of MI?

Answer 23

Age & Ejection Fraction

-measure ejection fraction on ECHO

Question 24

Describe SCD

Answer 24

Atherothrombus leads to Acute Myocardial Ischaemia leads to Ventricular Arrhythmia (VF)

Question 25

What can VF lead to?

Answer 25

Asystole- v v bad

Question 26

Treatment for VF?

Answer 26

EARLY Defib- only treatment