Cardiology-ACS Flashcards
(25 cards)
Criteria for AMI
Clinical evidence of
acute myocardial ischaemia and with detection of a rise
and/or fall of cTn values with one of the following: - - Symptoms of myocardial ischaemia;
- New ischaemic ECG changes;
- Development of pathological Q waves;
- Imaging evidence of new loss of viable myocardium or new
regional wall motion abnormality in a pattern consistent with
an ischaemic aetiology;
- Identification of a coronary thrombus by angiography or
autopsy (not for type 2 or 3 MIs)
What are the three types of ACS?
Unstable Angina, NSTEMI, STEMI.
What is the first-line treatment for STEMI?
Primary PCI within 90 minutes (or thrombolysis if PCI unavailable
What is the role of troponin in ACS diagnosis?
Elevated in NSTEMI & STEMI but normal in Unstable Angina.
What ECG changes are seen in STEMI?
ST elevation in contiguous leads with reciprocal ST depression.
What are the contraindications to beta-blockers in ACS?
Bradycardia, heart block, hypotension, decompensated heart failure
What is the TIMI score used for?
Risk stratification of UA/NSTEMI to guide early invasive strategy.
What medications are given in the acute management of ACS?
Nitrates, DAPT
What is the major goal of secondary prevention after ACS?
LDL <1.4 mmol/L, BP <130/80 mmHg, HbA1c <7%, smoking cessation, lifestyle changes
What are 3 initial investigations for ACS
- 12 lead ECG
- labs (Hb TRO anemia which causes SOB/CP)
- CXR (TRO dissection, APO
What are considered significant family history?
Significant family history for premature CAD
-First degree relatives
-Male younger than 55 years old
-Female younger than 65 years old
What is the 2nd cause of death in Singapore?
Acute coronary syndrome
Acute coronary syndrome encompasses conditions like unstable angina, NSTEMI, and STEMI.
What are the clinical presentations of acute coronary syndrome?
Unstable angina, NSTEMI, STEMI
These conditions are usually associated with rupture of an atherosclerotic plaque.
What does the clinical classification of chest pain include?
- Typical angina (definite)
- Atypical angina (probable)
- Noncardiac chest pain
Typical angina is defined by specific characteristics, while atypical angina meets two criteria and noncardiac chest pain meets one or none.
What is typical angina characterized by?
Substernal chest discomfort provoked by exertion or emotional stress, relieved by rest or GTN
GTN refers to glyceryl trinitrate, a medication used to relieve angina.
Fill in the blank: The initial investigations for acute coronary syndrome include _______.
12 lead ECG, labs, CXR
Labs typically include cardiac biomarkers (Hs-cTn), FBC, U/E/Cr, PT/INR.
What medications are used for unstable angina?
- Antiplatelet (aspirin, P2Y12 receptor inhibitors like Clopidogrel, Tica, Prasugel)
- Anticoagulation (SC clexane)
- Statin
Antiplatelet medications help prevent clot formation.
What defines a myocardial infarction?
Acute myocardial injury with evidence of acute myocardial ischemia and elevated cTn values
At least one cTn value must be above the 99th percentile URL.
What are common symptoms of myocardial infarction?
Chest pain, shortness of breath, nausea, sweating
Symptoms can vary among individuals.
What is the gold standard for investigating coronary artery disease?
Coronary angiogram
This procedure visualizes the coronary arteries to identify blockages.
What is involved in the management of acute pulmonary edema?
- Oxygen
- CPAP
- Diuretics
- ACE-i (captopril ultra short acting)
- ABG
- TTE
Management focuses on reducing afterload and managing fluid overload.
What is the purpose of a stress test in the context of cardiac evaluation?
To assess the heart’s response to stress, either physically or pharmacologically
This can include treadmill tests, stress echocardiography, or stress Mibi.
What factors are considered in the history taking for acute coronary syndrome?
- Pain interview (onset, location, duration, characteristics)
- Aggravating and relieving factors
- Treatment history
- Past medical history
- Medication history
- Social history
Family history of cardiac issues is significant, especially in younger relatives.
True or False: New ischemic ECG changes are a criterion for diagnosing myocardial infarction.
True
New pathological Q waves and imaging evidence of loss of viable myocardium are also criteria.
