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Cardiology Flashcards

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1
Q

What is acute coronary syndrome (ACS)?

A

A medical emergency involving acute myocardial ischaemic states requiring immediate hospital admission.

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2
Q

How is ACS classified?

A

By ECG findings and serial cardiac troponin levels.

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3
Q

What are the two main types of ACS?

A

ST-elevation ACS (STE-ACS) and Non-ST-elevation ACS (NSTE-ACS).

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4
Q

What defines ST-elevation ACS (STE-ACS)?

A

Acute chest pain with persistent (>20 min) ST-segment elevation, most developing STEMI.

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5
Q

What defines Non-ST-elevation ACS (NSTE-ACS)?

A

Chest pain without persistent ST-elevation; ECG may show ST depression, T-wave changes or be normal.

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6
Q

What are the two subtypes of NSTE-ACS?

A

Unstable angina and NSTEMI.

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7
Q

How are unstable angina and NSTEMI differentiated?

A

Unstable angina has normal troponins; NSTEMI has a rise in troponins.

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8
Q

Can the presentation of unstable angina, NSTEMI, and STEMI be distinguished clinically?

A

No, their presentations can be indistinguishable.

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9
Q

What are common symptoms of ACS?

A

Chest pain, sweating, nausea, vomiting, fatigue, shortness of breath, and palpitations.

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10
Q

Who may present without chest pain in ACS?

A

Elderly, diabetic patients, and some ethnic groups.

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11
Q

What is the role of a 12-lead ECG in ACS?

A

To confirm a cardiac basis for symptoms and detect structural or coronary disease.

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12
Q

Can a normal ECG exclude ischaemic chest pain?

A

No, a normal ECG does not rule out ischaemia.

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13
Q

What ECG changes are seen during angina episodes?

A

Transient ST-segment elevation, T-wave inversion, or ST-segment depression.

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14
Q

What is the typical ECG finding in unstable angina or NSTEMI?

A

T-wave inversion or ST-segment depression; ECG may be normal if pain resolved.

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15
Q

What are the key cardiac enzymes tested in ACS?

A

Troponin I and T.

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16
Q

When do troponins appear and peak after infarction?

A

Detected at 3–6h, peak at 12–24h, and stay elevated up to 14 days.

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17
Q

When are troponins usually tested after chest pain?

A

At 6 and 12 hours post-onset.

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18
Q

What does an elevated troponin indicate in ACS?

A

Increased risk of mortality short- and long-term; requires further inpatient assessment.

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19
Q

Why test FBC, renal function, and CRP in ACS?

A

To check for anaemia, assess kidney function, and measure inflammation.

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20
Q

What is the significance of blood glucose in ACS?

A

Hyperglycaemia is a poor prognostic marker, even without diabetes.

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21
Q

What can echocardiography show in ACS?

A

Wall motion abnormalities and causes of ischaemia like hypertrophy or valve disease.

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22
Q

What is the role of a chest X-ray in ACS?

A

To detect complications (e.g. pulmonary oedema) or rule out other diagnoses.

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23
Q

What can cardiac MRI (CMR) assess in ACS?

A

Function, perfusion, scar tissue, viability, and differential diagnoses like myocarditis.

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24
Q

What is the gold standard for assessing coronary artery disease?

A

Coronary angiography.

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25
Which medications should all MI patients be discharged with (unless contraindicated)?
ACE inhibitor, beta-blocker, statin, and dual antiplatelet therapy (aspirin + a second agent).
26
Which drug class is not routinely recommended post-MI to reduce cardiovascular risk?
Calcium channel blockers.
27
When can diltiazem or verapamil be used post-MI?
If beta-blockers are contraindicated or discontinued in patients without pulmonary congestion or LV systolic dysfunction.
28
Which calcium channel blocker is preferred in patients with heart failure post-MI?
Amlodipine.
29
Which calcium channel blockers should be avoided in heart failure patients?
Verapamil, diltiazem, and short-acting dihydropyridines (e.g. regular nifedipine).
30
Should nicorandil be used post-MI to reduce cardiovascular risk?
No, potassium channel activators like nicorandil should not be offered.
31
What are the key lifestyle changes recommended post-MI?
Smoking cessation, cardioprotective diet, physical activity, weight loss if overweight, alcohol within limits.
32
What does a cardioprotective diet include?
Low saturated fat, use olive/rapeseed oil, ≥5 fruits/veg/day, ≥2 fish servings/week (incl. oily fish), whole grains, low salt, low refined sugar.
33
What are the physical activity recommendations post-MI?
≥150 minutes/week of moderate-intensity aerobic activity or start at a comfortable level and build up.
34
How much alcohol is recommended post-MI?
≤14 units/week for men & women, spread over ≥3 days.
35
What is the purpose of cardiac rehabilitation post-MI?
Assessment, education, exercise, psychological support, lifestyle change, and risk factor management.
36
When should cardiac rehabilitation begin?
Usually initiated during hospital stay.
37
What components are included in cardiac rehab assessment?
BMI, diet, exercise habits, motivation, psychological status, symptoms, and cardiovascular risk factors.
38
What topics are covered in cardiac rehab education?
Heart disease risks, difference between MI and angina, medication use, exercise, return to work, diet.
39
What types of exercise are included in cardiac rehab?
Initial hospital-based individual programs followed by group activities like walking or swimming.
40
What validated home-based rehab programme may be offered?
The Heart Manual.
41
When can sexual activity be resumed post-MI?
Usually around 4 weeks, when the person feels comfortable.
42
Is erectile dysfunction (ED) common post-MI?
Yes, especially in men with CHD.
43
What ED treatments are safe post-MI?
PDE5 inhibitors like sildenafil, tadalafil, vardenafil in stable CHD (not with nitrates or nicorandil).
44
When should PDE5 inhibitors be avoided?
Low BP, severe heart failure (NYHA III–IV), refractory angina, recent CV event (<6 months), or using nitrates/nicorandil.
45
How soon can a person fly after an uncomplicated MI?
After 7 days.
46
How soon can a person fly after a complicated MI?
After 4–6 weeks.
47
How should ACE inhibitors be used post-MI?
Titrate to max tolerated dose, continue indefinitely, consider ARB if not tolerated.
48
How should beta-blockers be used post-MI?
Titrate to target dose, continue ≥12 months if no LVSD; continue indefinitely if LVSD present.
49
When can diltiazem or verapamil be considered instead of beta-blockers post-MI?
If BBs are not tolerated and patient does not have pulmonary congestion or LVSD.
50
What is the duration of dual antiplatelet therapy post-MI?
12 months (aspirin + second antiplatelet like clopidogrel, prasugrel, or ticagrelor).
51
When is aspirin continued indefinitely post-MI?
After completing 12 months of dual antiplatelet therapy.
52
When is clopidogrel used instead of aspirin post-MI?
If aspirin is contraindicated or not tolerated.
53
Who should get clopidogrel monotherapy post-MI after stopping dual therapy?
Those with vascular disease and MI >12 months ago or after stopping dual therapy.
54
How is antiplatelet therapy managed with anticoagulants post-MI?
Use one antiplatelet with anticoagulant (aspirin or clopidogrel based on treatment history).
55
When is clopidogrel preferred over aspirin in anticoagulated post-MI patients?
If aspirin is not tolerated or after PCI with stents.
56
Which antiplatelets should be avoided with warfarin?
Prasugrel and ticagrelor.
57
What should be done after 12 months of MI if on anticoagulants?
Continue anticoagulation and reassess need for antiplatelets – seek specialist advice if uncertain.
58
What annual vaccine is recommended post-MI?
Influenza vaccine.
59
What follow-up assessments are required post-MI?
Left ventricular function, bleeding risk, and coronary assessment.
60
Group 1 entitlement after MI
DVLA do not need to be notified If angioplasty successful, may drive after 1 week If angioplasty unsuccessful may drive after 4 weeks
61
Group 2 entitlement
Must notify the DVLA Disqualified Re/licensing may be considered after 6 weeks
62
STEMI management
1. 300mg aspirin 2. within 12 hour of symptom onset -> PCI can be performed within 120 minutes -> offer angiography 3. OVer 12 hours with myocardial ischarmia or shock OR can't be performed within 120 minutes -> fibrinolysis 4. no myocardial ischaemia or shock -> medical management
63
STEMI management alongside angiography
if taken oral anticoagulant already -> clopidogrel + aspirin if not taking oral anticoagulant -> prasugrel + aspirin Radial route offer unfractionated heparin + bailout GPI Femoral route -> offer bivalirudin _ bailout GPI If stenting offer drug eluding stent
64
Fibrinoysis or Medical management offer
low bleeding risk -> ticagrelor + aspirin high bleeding risk -> consider clopidogrel with aspirin Repeat ECG in 60-90 minutes afterwards Offer immediate angiography with follow on PCI if indicated by ECG
65
NSTEMI offer
initial antithrombin therapy: - low risk -> offer fondaparinux - high risk -> Grace score - if >creatine 265 micromol offer unfractionated heparin
66
Grace score
clinical history, physical exam, 12 lead ECG, blood test (Troponin I and T, creatine, glucose and haemoglobin)
67
low grace score - predicted 6month mortality ≤3%
medical management low risk of bleeding - ticagrelor + aspirin high risk of bleeding - clopidogrel + aspirin
68
intermediate or higher risk, predicted 6 month mortality ≥3%
Angiography + follow on PCI if indicated offer immediately if unstable or within 72 hours Not on anticoagulation - offer prasugrel or ticagrelor + aspirin On anticoagulation - offer clopidogrel and aspirin
69

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