Acute Coronary Syndromes Flashcards Preview

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Flashcards in Acute Coronary Syndromes Deck (28):
1

What change/event in the atherothrombotic process can lead to ACS (MI, stroke, unstable angina)?

Plaque rupture consequently occluding critical areas (coronary artery)

2

Describe chronic/stable angina

Fixed stenosis due to atheroma limits blood flow
Pain on exertion, relieved by rest/GTN spray

3

What are the 3 (main) acute coronary syndromes?

Unstable angina
NSTEMI
STEMI

4

What factors favour plaque rupture?

Thin fibrous cap
Sudden intraluminal pressure changes
High lipid content of plaque

5

How does plaque rupture affect the endothelium in terms of platelets?

Blood is exposed to sites it doesn't normally see
Platelets adhere to damaged areas through vWF and collectively form hemostatic plug

6

How does unstable angina differ from stable angina?

Pain caused by less and less exertion, in some cases eventually at rest
GTN becoming less effective

7

How does angina differ from acute MI?

Shorter (10 mins vs. 30 mins)
Pain on exertion (vs. rest)
GTN relief (vs. no relief)

8

What are typical ECG changes that occur in STEMI?

ST elevation
T wave inversion
Q wave formation

9

Why are Q waves "useful"?

Signal that there has been a previous MI

10

What characteristics must the ST elevation have in order to diagnose STEMI?

>1mm STE in 2+ adjacent limb leads
>2mm STE in 2+ contiguous precordial leads

11

Which leads show STE in an inferior MI?

II, III, aVF

12

Which leads show STE in an anterior MI?

V1-V6

13

Which leads show STE in an anterolateral MI?

I, aVL, V1-V6

14

Which leads show STE in an anteroseptal MI?

V1-V4

15

Which two proteins are used for diagnosing MI?

Troponin T or I
CK enzyme

16

When does CK production peak following an MI?

after 24 hours

17

Why is CK not commonly used solely anymore to diagnose MI?

Also present in skeletal muscle and brain, so elevated levels could be due to injury in these areas

18

What is the benefit of troponin T?

Highly specific for cardiac muscle damage

19

Outline immediate treatment of MI

diaMorphine
Oxygen if hypoxic
Nitrate (GTN) if BP >90
Aspirin
Clopidogrel
PCI within 90 mins, or else thrombolysis

20

If PCI cannot be given within 60 mins of seeing STEMI on ECG, do thrombolysis. True/False?

False
If PCI cannot be given within 90 mins (incorporating 40min drive time), then do thrombolysis

21

If a patient fails to improve following thrombolysis, what is done?

Emergency angioplasty

22

What is Dressler's syndrome?

Post-MI syndrome, occuring weeks after MI
Pleuritic pain, pericarditis, pericardial effusion

23

Could the ECG be normal in acute MI?

YES

24

In unstable angina, troponins may be normal. True/False?

True

25

In a patient with a bare metal stent, how long should clopidogrel therapy last?

3 months

26

Cardiac troponin levels are negligible in healthy people. True/False?

True

27

How long does it take for cardiac troponin levels to increase? How long do they remain elevated?

4-6 hours
Remain elevated for at least 7 days

28

Name some contraindications to thrombolysis

Trauma, haemorrhage
Recent surgery (within 2wks)
Recent stroke (within 6mths)
Severe hypertension
Active peptic ulcers