Cardio - ACS ppt Flashcards by 18 22

Q

clinical syndrome usually characterized by episodes or paroxysms of pain or pressure in the anterior chest

A

Angina pectoris

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Q

factors pptating angina (5)

A

Physical exertion
Exposure to cold
Eating a heavy meal
Stress or any emotion-provoking situation
Sexual activity

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Q

Canadian cardiovascular society classification of angina:

angina evoked after walking <2 blocks

A

III

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Q

Canadian cardiovascular society classification of angina:

angina evoked with prolonged exertion

A

I

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Q

Canadian cardiovascular society classification of angina:

angina evoked with minimal activity

A

IV

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Q

Canadian cardiovascular society classification of angina:

angina evoked with rest

A

IV

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Q

Canadian cardiovascular society classification of angina:

angina evoked with walking >2blocks

A

II

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Q

An unprovoked prolonged episode of chest pain raising suspicion of AMI without definite ECG or laboratory evidence

A

unstable angina

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Q

chest pain suggestive of AMI with nonspecific ECG changes, (ST depression/T inversion/normal) with laboratory tests showing release of tropnonins

A

NSTEMI

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Q

sustained chest pain, acute ST elevation or new LBBB with release of troponins

A

STEMI

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Q

Arrange the following in the correct order
A. Migration of monocyties
B.Growth factors
C. epithelial injury
D. foam cells
E. Atheromatous plaque forms

A

CADBE

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Q

Why is it possible for high grade stenoses to progress to complete occlusion but still do not precipitate acute STEMI?

A

due to collateral circulation

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Q

During development of plaques, abrupt transition can occur resulting in (3)

A

Platelet activation
Thrombin generation
Thrombus formation

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Q

What is the ultimate result of blood flow occlusion leading to imbalance between supply and demand?

a. Myocardial ischemia
b. Myocardial infarction
c. Myocardial necrosis
d. Myocardial apoptosis

A

C

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Q

This type of stenosis is likely to rupture causing thrombosis and STEMI

A

Less severe stenosis with lipid laden plaques and fragile caps

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Q

Caused by plaque formation, precipitated by stress or exertion, lasts <20min, relieved by NTG or resting

a. Stable angina
b. Unstable angina
c. NSTEMI
d. STEMI

A

A

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Q

platelet aggregation, chest paint at rest or minimal exertion, lasts >20min, often accompanied by other signs and symptoms, poor NTG relief. This is true for the following EXCEPT:

a. Stable Angina
b. Unstable Angina
c. NSTEMI
d. STEMI

A

A

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Q

what are the non-modifiable risk factors for ACS?

A

Increasing age

Gender (male)

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Q

Give 4 modifiable risk factors for ACS

A

Smoking
Obesity
Diet
Lack of exercise
High Serum Cholesterol
Hypertension
DM

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Q

Give 3 Respiratory ddx for chest pain

A

pulmonary embolism
pneumothorax
pneumonia

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Q

Give 3 GI ddx for chest pain

A

Esophageal spasm
GERD
Pancreatitis

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Q

Give 2 MSK ddx for chest pain

A

Costochondriasis

Trauma

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Q

Give 4 modifiable risk factors for ACS

A

Smoking
Obesity
Diet
Lack of exercise
High Serum Cholesterol
Hypertension
DM

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Q

Bedside investigations for ACS include (3)

A

Observation
ECG
BM

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Blood investigations for ACS include (7)

``` FBC UE LFT lipids cardiac enzymes amylase CRP ```

Imaging investigations for ACS include

CXR

Normal troponin a. UA b. NSTEMI c. STEMI d. B and C e. A and B f. AOTA

A

Raised Troponin a. UA b. NSTEMI c. STEMI d. B and C e. A and B f. AOTA

D

ECG normal a. UA b. NSTEMI c. STEMI d. B and C e. A and B f. AOTA

A

ST depression a. UA b. NSTEMI c. STEMI d. B and C e. A and B f. AOTA

C

ST elevation a. UA b. NSTEMI c. STEMI d. B and C e. A and B f. AOTA

C

New LBBB a. UA b. NSTEMI c. STEMI d. B and C e. A and B f. AOTA

C

T inversion a. hours b. days

A

Q waves a. hours b. days

B

ST elevation is __mm in limb leads and __mm in chest leads

1mm, 2mm

II,III avF

Inferior

I aVL, V5, V6

lateral

V1-2

Septal

V3-4

Anterior

V5-6

Lateral

Right coronary involvement a. Lateral b. Anterior c. Posterior d. Inferior

D

Left Circumflex (or LAD) involvement a. Lateral b. Anterior c. Posterior d. Inferior

A

Left circumflex or right coronary artery involvement a. Lateral b. Anterior c. Posterior d. Inferior

C

LAD a. Lateral b. Anterior c. Posterior d. Inferior

B (or A)

II, III avF a. Right coronary b. Left circumflex (LAD) c. LAD d. Left circumflex or right coronary

A

V3-V4 a. Right coronary b. Left circumflex (LAD) c. LAD d. Left circumflex or right coronary

C

I, aVL V5-6 a. Right coronary b. Left circumflex (LAD) c. LAD d. Left circumflex or right coronary

B

V1-3 ST depression a. Right coronary b. Left circumflex (LAD) c. LAD d. Left circumflex or right coronary

D

Common ACS management meds

``` MONA morphine oxygen Nitrates Aspirin ```

dose of morphine in ACS

5-10 mg slow IV injection

ACS management: Nitrates GTN spray dose

400mcg = 1 spray

ACS management: Nitrates dose tablet

1mg

ACS management: Aspiring dose

300mg chewed

The following can be given in ACS management EXCEPT a. morphine b. oxygen c. nitrates d. aspiring e. metoclopramide f. NOTA

F

Unstable angina and NSTEMI meds (5)

LABN LMWH Aspirin Beta Blocker Nitrates

Predicts 6/12 mortality in NSTEMI patients a. GRACE scoring b. TIMI

A

Predicts Risk of cardiac events in next 30 days a. GRACE scoring b. TIMI

B

Door to balloon time in PCI for STEMI

120 min

PCI requires a. aspirin 300 mg b. clopidogrel 300 mg c. both d. neither

C

Door to needle time for thrombolysis in STEMI

90 min

Thrombolytic agents given in STEMI (3)

streptokinase alteplase tenecteplase

aspirin 300mg/ clopidogrel 300mg a. PCI b. Thrombolysis c. both d. neither

C

dose of aspirin for lifelong long-term management

75 mg OD

Dose of clopidogrel for 1 year

75 mg

How long should beta blockers be given

1 year to lifelong

Complications <72 hr (early)

``` Death cardiogenic shock heart failure ventricular arrhythmia myocardial rupture thromboembolism ```

Late complications (>72 hrs)

``` ventricular wall rupture valvular regurgitation ventricular aneurysms cardiac tamponade dresslers syndrome thromboembolism ```