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Acute Coronary Syndromes (ACS) Flashcards

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1
Q

What is an ACS?

A

Any sudden cardiac event related to a problem with the coronary arteries (problems arise du to myocardial ischaemia)

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2
Q

How can an atheroma lead to a MI?

A
  • Fibrous cap of plaque injured and thrombus formed
  • In more advanced, cap completely ruptures - contents released and thrombus forms

Platelets release serotonin and thromboxane A2 - causes vasoconstriction in the area (ischaemia)

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3
Q

What are the symptoms of ACS?

A

Chest pain
Nausea
Sweating
Breathless

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4
Q

Describe ischaemic chest pain

A

Dull retrosternal pain
More of a pressure
May radiate to jaw, neck, arm

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5
Q

What are the signs on clinical examination?

A 
3rd HS (early diastole) 
Pansystolic murmur (S1 to S2) 
Pericardial rub 
Crepitations in lung - Pul. oedema 
Hypotension 
Quiet S1
Narrow pulse pressure 
Raised JVP
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6
Q

How is the diagnosis made?

A
  1. History - signs/symptoms
  2. ECG changes
  3. Positive cardiac enzyme tests - troponin and creation kinase
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7
Q

What investigations should be carried out?

A

ECG

FBC 
U+E 
LFT
TFT
Blood glucose (diabetes)
Lipid profile 
Cardiac enzymes 
ABG

CXR

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8
Q

What is the general management of suspected ACS?

A 
Morphine 
O2
Nitrates (GTN)
Aspirin 
Clopidogrel
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9
Q

What is given got for STEMI treatment?

A

Thrombolysis (TNK)
PCI
B blockers
ACEi

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10
Q

What is given for NSTEMI treatment?

A 
CABG 
Antiplatelet (aspirin, Clopidogrel)
Anti-thrombotic (heparin, fonaparinux)
BB (bisorolol) - peripheral vasodilation - reduces CO, HR and contractility 
Statin (simvastin)
ACEi (ramipril)
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11
Q

What are the risk factors of ACS?

A 
Male
Age 
Known heart disease 
High BP 
High cholesterol 
Diabetes 
Smoker
FH of premature heart disease
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12
Q

What is the action of antiplatelet agents?

A

Aspirin inhibits thromboxane A2 production which stimulates platelet aggregation and vasoconstriction, abnormal blood flow (causing atheroma) and vasospasm

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13
Q

What is the action of glycoprotein II/b/IIa receptor inhibitors?

A

GPIIb/IIa is a complex on platelet, and the receptor for fibrinogen aids in platelet activation

Clopidogrel blocks by inhibiting fibrinogen from binding to GPIIb/IIa receptor.

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14
Q

What is the action of BB?

A

Competitively inhibit myocardial effects of circulating catecholamines and reduce myocardial O2 consumption by lowering HR, BP and contractility

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15
Q

What is the goal of pharmacotherapy?

A

Increase myocardial O2 supply through coronary vasodilation

Decrease myocardial O2 demand by decreasing HR, BP, preload or myocardial contractility

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16
Q

What is a major (full blown) MI?

A

Complete coronary artery occlusion

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17
Q

What is a minor (warning) MI?

A

Partial (or transient complete) coronary artery occlusion

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18
Q

What does the initial ECG of a complete coronary occlusion show?

A

ST elevation

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19
Q

What does the ECG of a complete coronary occlusion show after 3 days?

A

Q waves

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20
Q

What does the initial ECG of a partial coronary occlusion show?

A

No ST elevation

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21
Q

What does the ECG of a partial coronary occlusion show after 3 days?

A

No Q waves

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22
Q

Is stable angina an acute coronary syndrome?

Study These Flashcards
A

No, it is a chronic ischaemic heart disease

23
Q

Is unstable angina an acute coronary syndrome?

24
Q

In a STEMI what thickness of the heart muscle is affected?

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A

Full thickness (transmural MI)

25
In a NSTEMI what thickness of the heart muscle is affected?
Partial thickness (subendocardial MI)
26
How is MI diagnosed?
+Ve cardiac biomarkers (myocyte death) ``` AND one of: Ischaemic symptoms ECG changes Angiogram shows coronary problem Cardiac damage on another test ```
27
What protein is used as a biomarker to detect if a major MI has occurred?
Troponin B1
28
What protein is used as a biomarker to detect if a minor MI has occurred?
Troponin B2
29
What are some non-cardiac causes of troponin rise?
Pulmonary embolism Sepsis Renal failure Sub-arachnoid haemorrhage
30
What is a Type I MI?
A spontaneous MI associated with ischaemia and due to primary coronary events such as plaque erosion, rupture, fissuring or dissection
31
What are some other causes of type 1 MI that are not atherosclerosis?
Coronary vasospasm Coronary dissecion Embolism of coronary artery Inflammation of coronary artery (vasculitis) Radiotherapy to chest can cause fibrosis and stenosis of coronary arteries
32
What might the ST segment of the ECG look like in a NSTEMI?
Could be ST depression
33
Why can posterior MI be easily missed?
A there are no chest lead on the back of the chest
34
What MI can a problem with the right coronary artery cause?
Inferior MI
35
What MI can a problem with the LAD coronary artery cause?
Anterior MI
36
What MI can a problem with the L circumflex coronary artery cause?
Lateral MI
37
For posterior MI, what precordial chest lead should you look at on an ECG?
V1-V2 as you see opposite changes as they're opposite the posterior side
38
How many cases per year of MI are there?
300 000
39
What can a CXR show in an ACS?
Cardiomegaly Pul. oedema Widened mediastinum
40
What are two treatments that restore reperfusion of occluded artery?
Primary percataneous coronary intervention (PCI) | Pharmacological
41
What are you looking for in FBC investigation?
``` Anaemia Inflammation markers (WBC) ```
42
What are two cardiac enzymes?
Troponin | Creatine kinase
43
What is the thrombolysis agent used?
Tenecteplase (TNK)
44
What do you need to be about with thrombolysis?
Bleeding Dont give to those if recent stroke or previous intracranial bleed Caution if recent surgery, on warfarin, severe HPT
45
Cath lab vs thrombolysis
Cath lab for PCI first choice if you can get to it with 2hrs Thrombolysis works if given early but likely to cause bleeding
46
What type of individuals are more likely to get an NSTEMI than STEMI?
Older Prev MI Prev CABG/PCI
47
What is the management given more more chest pain after admission?
GTN - vasodilation of coronary arteries | Opiates (morphine) - relieve anxiety and venodilates
48
List 2 anti platelet drugs
``` Aspirin Clopidogrel (or ticagrelor 180mg then 90mg bd) ``` Both 300mg then 75mg od
49
List 3 anti-thrombotic drugs
Heparin LMWH Fondaparinux (2.5mg od)
50
What are the risks of coronary stunting?
``` Bleeding Blood vessel damage MI Coronary perforation Stroke Dye can affect kidneys ```
51
What are the complications following an MI?
Arrhythmias | Mechanical: cariogenic shock, myocardial rupture
52
What are other mechanical problems hat can arise from MI but not cause death?
Valve dysfunction due to papillary muscle dysfunction/rupture Acute ventricular septal defect
53
Why are anti platelets required after a stent?
Takes time for stent to become endothelialised into coronary artery wall, so until then it is exposed to blood and can cause thromboses, blocking off the stent unless of antiplatelets 1 to 12 months of dual anti-platelet therapy (DAPT)

Cardiovascular System (37 decks)

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