Acute coronary Syndromes

Question 1

What are risks of CVD?

Answer 1

smoking
hypertension
hypercholesterolaemia (high cholesterol)
diabetes
obesity
male sex
family history of early coronary artery disease
ethnicity
social deprivation

Question 2

Why have death rates due to CVD declined?

Answer 2

fewer people smoking

screening and treatment for other CV risk factor

improved treatments for CV disease

Question 3

statins do what?

Answer 3

a group of medicines that can help lower the level of low-density lipoprotein (LDL) cholesterol in the blood

Question 4

What are modofiable risk factors?

Answer 4

smoking
hypertension
hypercholesterolaemia (high cholesterol)
diabetes
obesity

Question 5

What are non-modifiable risk factors?

Answer 5

male sex
family history of early coronary artery disease
ethnicity
social deprivation

Question 6

What are 3 types of symptoms for CVD?

Answer 6

stable (stable angina)

ACS - acute coronary symptoms

atypical/non-cardiac symptoms

Question 7

What are stable symptoms of CVD?

Answer 7

chest pain/tightness on exertion - reproducible

may radiate to either arm or jaw - small minority of pts may think they have dental disease

often described as dull, heavy, tight, pressure, indigestion

angina equivalent - often breathlessness. much less specific

Question 8

What is CVD stable symptoms described as?

Answer 8

often described as dull, heavy, tight, pressure, mistake for indigestion

Question 9

What is angina equivalent?

Answer 9

often breathless

don’t have typical symptoms

hard to know whether it is the heart

Question 10

What symptoms are more severe stable or ACS?

Answer 10

acute coronary symptoms

Question 11

Describe the symptoms for ACS?

Answer 11

Chest pain/tightness, persisting at rest at rest or onset after very minimal exertion

pain is not always severe, especially in NSTEM (non-stem)

associated symptoms - nausea, vomiting, sweating, breathless

Question 12

What are symptoms of ACS?

Answer 12

nausea, vomiting, sweating, breathless

Question 13

Are pts undergoing cardiac arrest always in severe pain?

Answer 13

not always

Question 14

What are the atypical/non-cardiac symptoms?

Answer 14

sharp pain - can locate a specific location

pain localised to small area of the thorax

worse on inspiration

chest wall tenderness/pain worse on movement

syncope (blackouts)

Question 15

with regards to atypical pain, what do you call pain on inspiration?

Answer 15

Pleuromeia

Question 16

What is the disease that CVS pts have?

Answer 16

atherosclerosis

Question 17

Describe atherosclerosis?

Answer 17

blood vessel = 3 layers

endothelium gets damaged e.g. high blood sugar, diabetes, smoking

now lipids get into the wall of the vessel and for a plaque - atherosclerotic plaque (yellow)

Question 18

Describe atherosclerotic plaque?

Answer 18

lipids at the core and fibrous coating around the outside

Question 19

In stable coronary disease, what is the atherosclerotic plaque formation like?

Answer 19

gradual - the artery becomes gradually more narrowed

ischemia of myocardial tissue and cardiac arrest

Question 20

In unstable coronary disease, what is the atherosclerotic plaque formation like?

Answer 20

more sudden

often an area with mild plaque - the fibrous cap over the top ruptures open

lipid core exposed to blood

then a cascade of platelet activation - thrombus form on top and blocks artery and causes sudden chest pain at rest

Question 21

What happens if the thrombus completely blocks the artery?

Answer 21

causes ST-elevation myocardial infarction (STEMI)

an event in which transmural myocardial ischemia results in myocardial injury or necrosis

LESS SEVERE HEART ATTACK

Question 22

What is STEMI?

Answer 22

an event in which transmural myocardial ischemia results in myocardial injury or necrosis

ST-elevation myocardial infarction (STEMI)

Question 23

3 types of acute coronary syndrome?

Answer 23

STEMI

Non-STEMI

unstable angina

Question 24

symptoms of STEMI?

Answer 24

chest pain

ST elevation on ECG

rise in troponin

Question 25

symptoms of non-STEMI?

Answer 25

chest pain no ST elevation on ECG rise in troponin

Question 26

symptoms of unstable angina?

Answer 26

unstable chest pain no ST elevation on ECG no rise in troponin

Question 27

What is angina?

Answer 27

Angina is where you have attacks of chest pain caused by reduced blood flow to your heart.

Question 28

What is cardiac troponin?

Answer 28

troponin T and I are cardiac regulatory proteins that control calcium mediated interaction between actin and myosin

Question 29

2 types of cardiac troponin?

Answer 29

T and I

Question 30

What does elevated troponin mean?

Answer 30

serum levels indicate myocardial damage

Question 31

What can you do if a pts history is suggestive of MI?

Answer 31

serum troponin is used to either confirm or exclude the diagnosis

Question 32

Can cardiac troponin be elevated due to other reasons other than MI?

Answer 32

YES

Question 33

What are the 3 parts of an ECG to be aware of?

Answer 33

P wave QRS complex T wave

Question 34

What does the P wave highlight on ECG?

Answer 34

atrial depolarisation = contraction

Question 35

What does the QRS complex highlight on ECG?

Answer 35

ventricular depolarisation

Question 36

What T indicate on the ECG?

Answer 36

ventricular repolarisation

Question 37

What does ST elevation mean?

Answer 37

ST segment is elevated

Question 38

Normal or not normal ECG?

Answer 38

NORMAL P wave QRS complex T wave

Question 39

What is the name of the line the arrow is pointing to?

Answer 39

isoelectric line

Question 40

Normal or not normal ECG?

Answer 40

NOT NORMAL person having a STEMI

Question 41

How can you tell this person is having a STEMI?

Answer 41

first column - THE SEGEMBNT ABOVE THE ISOELECTRIC LINE artery in heart is blocked

Question 42

What is VF?

Answer 42

a type of irregular heart rhythm (arrhythmia) VENTRICULAR FIBRILATION unorganised electrical activity

Question 43

What does VF always cause?

Answer 43

MI pt usually unconscious

Question 44

What is the treatment for VF?

Answer 44

CPR + DC cardioversion (ALS algorithm) from defibrillator

Question 45

Medications to treat ACS?

Answer 45

Aspirin - antiplatelet other antiplatelet drugs - clopidogrel, ticagrelor, prasugrel statins ACE inhibitors MRA - mineralocortocoid receptor antagonists beta-blocker

Question 46

What do the alternative antiplatelet drugs act upon?

Answer 46

P2Y12 receptor inhibitor

Question 47

Does aspirin or the alternative antiplatelet drugs have a higher risk of bleeding?

Answer 47

the alternative antiplatelet drugs clopidogrel, ticagrelor, prasugrel

Question 48

Why are statin prescribed for ACS?

Answer 48

inhibit the production of LDL from the liver - BAD CHOLESTEROL

Question 49

Examples of statins?

Answer 49

atorvastatin, rosuvastatin, simvastatin

Question 50

Why are ACE prescribed used for ACS?

Answer 50

ramipril perindopril lisinopril

Question 51

What drug is used to treat pts with heart failure after MI?

Answer 51

mra - mineralocorticoid receptor antagonists

Question 52

What beta-blockers are prescribed for ACS?

Answer 52

bisoprolol atenolol metoprolol

Question 53

Why prescribe beta blockers for ACS?

Answer 53

are drugs used to treat angina, lower blood pressure, protect against recurrent heart attacks prevent VF

Question 54

What is an alternative to medications for ACS?

Answer 54

revascularisation

Question 55

What are to ways to achieve revascularisation for ACS?

Answer 55

1. percutaneous coronary intervention (PCI) 2. Coronary artery bypass surgery (CABG)

Question 56

What is PCI?

Answer 56

small metal cage delivered on a wire in the artery it squashes the plaque out the way allows blood flow down the artery

Question 57

What is CABG?

Answer 57

2 ways: harvesting a vein form the leg - stitching it on to the aorta and to the coronary artery beyond the narrowing - restoring the blood flow using arteries within the chest wall - can be used as well

Question 58

CABG vs PCI?

Answer 58

CABG doesn't do anything directly to the plaque causing the blockage

Question 59

When is the bypass sugery good to use?

Answer 59

when a pt has 2 or more major coronary arteries affected or left main stem stenosis and diabetic

Question 60

What is DAPT?

Answer 60

dual antiplatelet therapy = aspirin with one of the other ACS drugs

Question 61

What does ST elevation indicate?

Answer 61

occurs due to occlusion of one or more coronary arteries, causing transmural myocardial ischemia which in turn results in myocardial injury or necrosis.