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FINALS - CARDIO > acute coronary syndromes > Flashcards

acute coronary syndromes Flashcards

(67 cards)

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1
Q

what presentations does ACS cover

A

STEMI, NSTEMI, unstable angina

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2
Q

how is an NSTEMI differentiated from unstable angina

A

no rise in troponin + no ECG changes

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3
Q

basic pathophsiology of atherosclerosis

A

endothelial dysfunction –> oxidaisation + phagocytosis of LDLs –> foam cells –> fibrous capsule over plaque

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4
Q

how do fatty plaques lead to IHD

A

narrowing of coronary vessels // rupture –> occlusion

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5
Q

presentation ACS

A

central chest pain // radiate to jaw or left arm // heavy pain // sweating // SOB

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6
Q

invx for ACS

A

ECG + troponin

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7
Q

who is an atypical presentation of ACS more common in (ie less pain)

A

elderly, diabetics, women

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8
Q

inital mx for all ACS patients

A

aspirin 300mg // nitrates // O2 if sats <94% // Morphine if needed

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9
Q

when in ACS would nitrates need to be held

A

hypotensive

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10
Q

how is STEMI diagnosed

A

symptoms >20 mins + ECG features >2 mins in at least 2 leads

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11
Q

when is PCI considered for STEMI

A

first line if present within 12 hours and PCI can be delivered in 120 mins

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12
Q

what artery is accessed for PCI and what stent is used

A

radial > femoral // drug-eluting stent

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13
Q

what is done if PCI cannot be offered within 120 minutes

A

fibrinolysis

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14
Q

prior to PCI what antiplatelets are given

A

aspirin + prasugrel (if not on anticoag) or clopidogrel (if on anticoag)

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15
Q

what medication is given during PCI

A

heparin + bailout GPI

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16
Q

what mediation should be given at the same time as fibrinolysis in a STEMI

A

antithrombin eg dabigatran, faundiparux

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17
Q

when should an ECG be repeated after fibrinolysis + what should be done if symptoms persist

A

ECG after 60-90 mins –> PCI

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18
Q

when would PCI be considered in NSTEMI or unstable angina

A

if risk assessment = 3%> (eg GRACE assessment)

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19
Q

if PCI or angiography is not planned in NSTEMI/ unstable angina what drug should be given

A

antithrombin eg fondaparoux + (aspirin + tricagrelor)

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20
Q

which patients with NSTEMI/ unstable angina should recieve immediate angio (+/- PCI)

A

clinically unstable eg hypotensive

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21
Q

which patients with NSTEMI/ unstable angina should recieve angio (+/- PCI) within 72 hours

A

GRACE score >3%

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22
Q

for those at low risk after NSTEMI/ unstable angina, and LOW risk of bleeding, what conservative treatment is given

A

aspirin + ticagrelor

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23
Q

for those at low risk after NSTEMI/ unstable angina, and HIGH risk of bleeding, what conservative treatment is given

A

aspirin + clopidogrel

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24
Q

what does the Killip class determine

A

30 day mortality post MI

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25
what is Killip class 1
no signs of heart failure
26
what is Killip class 2-3
2 = lung crackles // 3 = frank pulm oedema
27
what is killip class 4
cardiogenic shock (80% mortality)
28
what 3 things make typical angina
constricting chest, neck, shoulder, jaw pain + exacerbated by exercise + relieved by GTN
29
what makes atypical angina
2/3 things
30
if clinical assessment not enough for stable angina, what is 1st line invx
CT coronary angio
31
2nd and 3rd line invx stable angina
2nd = non invasive imaging (eg SPECT, echo, MRI) // 3rd = invasie
32
2nd and 3rd line invx stable angina
2nd = non invasive imaging (eg SPECT, echo, MRI) // 3rd = invasie
33
what initial mx should all patients presenting with chest pain get
GTN + 300mg aspirin
34
what should all patients with stable angina be started on
aspirin + statin
35
1st line drugs for stable angina
beta blocker or CBB (verapmil or diltiazem)
36
if monotherapy not working what mx is done for stable angina
max dose monotherapy --> CCB + beta blocker
37
if dual therapy is used in stable angina what CCB must be used
amlodopine or nifedepine (verapamil + BB --> heart block)
38
if dual therapy cannot be tolerated in stable angina what drugs should be considered
long acting nitrate eg isosorbide mononitrate // ivabrandine // nicorandil
39
what dosing is required with isosorbide mononitrates
asymmetric dosing so there is a nitrate free period of 10-14 hours to prevent tolerance
40
what should all patiens with STEMI recieve
aspirin + tricagrelor/ clopidogrel (or prasugrel if going for PCI)
41
what drug is given to STEMI patients during PCI
unfractionated heparin (if unsuitable LMW heparin)
42
when is O2 given in a STEMI
<94%
43
1st line mx STEMI
PCI within 2 hours
44
what drug is given during thrombolysis
tissue plasminogen activator (tPa) eg alteplase
45
contraindications to thrombolysis
active or recent haemorrhage // coag or bleeding disorders // brain tumur // recent stroke
46
after an MI what drugs shuld all patients recieve (4)
dual antiplatelet (aspirin +...) // ACEi // BB // statin
47
what antiplatelets are commonly given after a medically managed ACS
aspirin (lifelong) + tricegrelor (12 months)
48
what antiplatelets are commonly given after a PCI managed MI
aspirin + tricegrelor (or prasufel) (12 months)
49
what drug can be given post MI for patietns with HF and left ventricular dysfunction
eplerenone started 3-14 days after
50
most common cause of death following an MI
v fib --> arrest
51
what type of MI can cause bradyarrhythmias
inferior MIs
52
when is pericarditis common post MI + symptoms
48 hours --> pericardial rub + effusion (ECHO)
53
what is dresslers syndrome
2-6 weeks post MI --> fever, pleuritic pain, effusion, raised ESR
54
how is dresslers syndrome managed
NSAIDs
55
how would left ventricular aneurysm present afer an MI
persistent ST elavation + LV failure
56
how would LV rupture present post MI
1-2 weeks later --> tamponade (raised JVP, pulsus paradoxus, reduced heart sounds)
57
how would ventricular septal defect present post MI
1st week --> acute HF, pansystolic murmur (ECHO)
58
how can acute mitral regurg occur post MI
ischaemia or rupture of papilliary muscle
59
how can acute mitral regurg present
acute hypotension + pulmonary oedema
60
how does a posterior MI present on an ECG
ST depression not elevation
61
what ECG changes could indicate a STEMI
ST elevation or new LBBB
62
what ECG changes could indicate a NSTEMI
ST depression // deep T wave inversion // pathological Q waves
63
what leads + artery indicate an anteroseptal MI
V1-V4 + LAD
64
what leads + artery indicate an inferior MI
II, III, aVF + right coronary
65
what leads + artery indicate an anterolateral MI
V1-6, I, aVL (LAD)
66
what leads + artery indicate an lateral MI
I, aVL, V5-6 (left circumflex)
67
what leads + artery indicate an posterior MI
changes in V1-3 (orV7-9) (usually ST depression) // left circumflex or right coronary

FINALS - CARDIO (17 decks)

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