Acute Coronary Syndromes

Question 1

Main cause of an MI

Answer 1

Atherosclerosis

Question 2

Causes of MI

Answer 2

Atherosclerosis,
Coronary vasospasms (due to cocaine or 5-FU),
Inflammation of coronary arteries (vasculitis),
Radiotherapy to chest

Question 3

Cardiac biomarkers

Answer 3

TROPONIN,
Myoglobin,
CK_MB

Question 4

Right coronary artery supplies what part of the heart?

Answer 4

Inferior heart

Question 5

Left anterior descending coronary artery supplies which part of the heart?

Answer 5

Anterior

Question 6

Circumflex artery supplies which part of the heart?

Answer 6

Lateral

Question 7

Symptoms of MI?

Answer 7

Crushing chest pain, 
Pain radiated to left jaw and arm, 
SOB,
Tachycardia, 
N/v,
Heartburn,
Dizziness, 
Fatigue

Question 8

Initial treatment of MI

Answer 8

Cath lab for primary percutaneous cornonary intervention or thrombolysis

Question 9

Thrombolysis agents used?

Answer 9

Tenecteplase,
Alteplase,
Streptokinase

Question 10

Discharge after MI treatment?

Answer 10

Antiplatelet,
ACE inhibitor
bblockers,
statins

Question 11

Contraindications for thrombolysis

Answer 11

Intracranial haemorrhage,
Stroke within 3 months, 
Head injury within 3 months,
Brain tumours, 
Pregnancy,
Sever hypertension, 
Major surgery in past 3 weeks, 
Internal bleeding in past 2-4 weeks, 
Trauma, 
Active peptic ulcer

Question 12

ECG appearance in STEMI

Answer 12

ST elevation

Question 13

ECG appearance in NSTEMI

Answer 13

ST depression or

T inversion

Question 14

Patterns of infarct?

Answer 14

Transmural- all of myocardial wall

Subendocardial- <50% of myocardial wall

Question 15

Investigations for MI?

Answer 15

ECG,
CXR,
Bloods- cardiac biomarkers,
Angiography

Question 16

What other conditions can raise troponin?

Answer 16

PE,
sepsis,
renal failure,
subarachnoid haemorrhage

Question 17

Signs of MI?

Answer 17

RIP
Raised JVP,
Increased pulse
Pallor

Question 18

Complications of MI?

Answer 18

C PEAR DROP

Cardiogenic shock

Pericarditis
Emboli
Aneurysm,
Rupture of ventricle

Dressler’s syndrome,
Rupture of free wall
Papillary muscle rupture

Question 19

Risk factors for MI?

Answer 19

Male, 
advanced age, 
heart disease, 
hypertension, 
high cholesterol, 
diabetes, 
smoker,
FH of heart disease

Question 20

What is Dressler’s syndrome?

Answer 20

Autoimmune pericarditis that can develop 2-10 weeks post MI.

Triad of- fever, pleuritic pain, pericardial effusion