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Cardiovascular System > Acute Coronary Syndromes:Presentation and Management > Flashcards

Acute Coronary Syndromes:Presentation and Management Flashcards

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1
Q

What is an Acute Coronary Syndrome?

A

• Any sudden event suspected or proven to be related to a problem with the coronary arteries, which can arise due to myocardial iscahaemia

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2
Q

What is a Myocardial Infarction

A

Death due to ischaemia and can be partial or complete occlusion of coronary artery

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3
Q

What is a cardiac arrest

A

Abnormal heart rhythm not compatible with life such as VF, tachycardia, asystole

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4
Q

When can cardiac arrest occur (3)

A

During acute phase of MI
Late after an MI
Unrelated to MI

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5
Q

Chronic Ischaemic Heart Disease

A

• Stable angina

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6
Q

Acute Coronary Syndromes (2)

A

• Unstable angina
• Myocardial infarction (plaque disruption and platelet aggregation:
-NSTEMI
-STEMI

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7
Q

Initial ECG of transmural MI and after 3 days

A

ST elevation and Q wave

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8
Q

Initial ECG of subendocardial MI and after 3 days

A

No ST elevation and no Q wave

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9
Q

Diagnosis of MI (5)

A

Detection of cell death or injury (troponin)
 Symptoms of ischemia
 New ECG changes
 Evidence of coronary problem on coronary angiogram or autopsy
 Evidence of new cardiac damage on another test

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10
Q

Non-coronary causes of troponin rise (6)

A 
Pulmonary embolism
Cardiac contusion
Anaemia
Sepsis
Renal failure
Sub-arachnoid haemorrhage
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11
Q

Type 1 MI

A

Spontaneous

Associated with ischaemia due to plaque erosion, rupture, fissuring or dissection

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12
Q

Type 2 MI

A

Due to imbalance in supply and demand. Result of ischaemia but not due to thrombosis of coronary artery

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13
Q

Type 3 MI

A

Sudden cardiac death
Symptoms of ischaemia
ST elevation
LBBB

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14
Q

Type 4a MI

A

Associated with percutaneous coronary intervention- increase biomarkers 3 X 99th percentile of the upper reference limit

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15
Q

Type 4b

A

MI associated with verified stent thrombosis via angiography

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16
Q

Type 5 MI

A

MI associated with CABG (plus new Q waves or LBBB or imagine evidence of new loss)

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17
Q

Causes of type 1 MIs not related to coronary atherosclerosis (5)

A 
Coronary vasospasm
Coronary dissection
Embolism of material
Inflammation
Previous radiotherapy
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18
Q

Causes of coronary vasospasm

A

Cocaine, triptans, 5-FU

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19
Q

Embolism of material

A

Thrombus or tumour

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20
Q

Inflammation of coronary arteries is known as

A

Vasculitis

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21
Q

Previous radiotherapy to chest causes

A

Fibrosis and stenosis or coronary arteries

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22
Q

Presentation of ACS (5)

A 
Chest pain
May radiate to neck and arm
More discomfort than pain
Severe but not in agony
May be associated with nausea, sweating and SOB
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23
Q

Cardiac Risk Factors (8)

A
  • Male
  • Age
  • Known heart disease
  • High BP
  • High cholesterol
  • Diabetes
  • Smoker
  • Family history of premature heart disease
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24
Q

Examination (5)

A
  • May look unwell
  • May look completely fine
  • Often no specific features to find
  • Check HR, BP
  • Listen for murmurs, crackles in chest
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25
Key investigation
ECG
26
T wave in NSTEMI
T wave inverted
27
T wave in STEMI
hyper-acute T waves
28
what occlusion is easily missed
LCx
29
Anterior MI ECG
V1-V4
30
Lateral MI ECG
V5-V6
31
Inferior MI ECG
II, III, aVF
32
High Lateral MI ECG
I, aVL
33
Posterior MI
V1-V2 (opposite changes in the leads opposite those looking at that area)- some inferior ST elevation
34
Diagnosis
Symptoms ST elevation? Troponin elevation Q wave?
35
Typical angina for >20 minutes
yes- Acute coronary syndrome | No- stable angina
36
ST elevation
Yes- STEMI | No- test troponin level
37
Troponin elevated
Yes- NSTEMI | No- unstable angina
38
After 3 days Q wave?
Yes- QwMI | No- MQMI
39
Posterior ECG leads
V7, V8, V9
40
Inferior MI
RCA
41
Anterior MI
Left anterior descending coronary artery
42
Lateral MI
Circumflex coronary artery
43
Mechanical Reperfusion therapy
Angioplasty and stenting in cath lab
44
Pharmacological Reperfusion Therapy
Thrombolysis (Tenecteplase)
45
Risks of Thrombolysis
``` Bleeding Recent stroke/intracranial bleed Recent surgery On Warfarin Sever Hypertension ```
46
During STEMI within 2 hours what treatment can you give
PCI
47
During STEMI after 2 hours what treatment can you give
Thrombolysis then transfer
48
NSTEMi compared to STEMI (4)
Seen in older patients Previous CABG/MI/PCI More likely to have medical problems Presentation may not be obvious or clear
49
Signs and symptoms during unstable angina (5)
``` Convincing anginal symptoms Rapidly worsening (crescendo) Occurring at rest ECG may be normal or abnormal No cell death so troponin is not elevated ```
50
General management of ACS
Hospitalisation Cardiac monitoring Oxygen if levels are low
51
Investigations
ECGs Posterior leads Blood tests (troponin, kidney, Hb, cholesterol)
52
Treatment
GTN (vasodilators)- sublingual IV infusion | Opiates (morphine) reduce anxiety venodilator
53
Anti-thrombotic drugs (anti-platelet) (3)
Aspirin Clopidogrel Ticagrelor
54
Anti-coagulant drugs (3)
LMWH Unfractionated Heparin Fondaparinux
55
Other Drugs
Beta Blockers | ACEI
56
Do patients with NSTEMI also need a coronary angiogram (2)
Ideally within 48 hours | Use risk calculator to assess risk
57
Risks of coronary angiography and angioplasts/stents (6)
``` Bleeding Blood vessel damage MI Coronary perforation Stroke Contrast nephropathy ```
58
What is CABG used to treat (2)
3 vessel disease | Left main stem disease
59
Management in hospital (3)
Home within 3-4 days Keep monitor for first 24-48 hours Get an echo
60
Course in Hospital (2)
Listen for murmurs and signs of HF | Secondary prevention drugs
61
Complications following an MI (4)
Arrhythmia Myocardial rupture Acute ventricular septal defect Mitral valve dysfunction due to papillary muscle rupture
62
Pre-discharge arrangements (5)
``` Check correct medications Address risk factors Smoking cessation Arrange cardiac rehabilitation Make follow up plans ```
63
Anti-platelet therapy precautions(4)
Takes time for stent to become endothelised into coronary artery wall Blood exposed to metal stent can thrombose and block off stent Antiplatelets required for 1-12 months Premature discontinuation can be fatal
64
Longer term complications
High risk of future MI/death Cardiac failure Risk of bleeding (anti-platelets) Will have to delay other operations due to being on antiplatelet drugs

Cardiovascular System (42 decks)

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