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RACP Written 2018 > Cardiology - Acute Coronary Syndrome > Flashcards

Cardiology - Acute Coronary Syndrome Flashcards

(39 cards)

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1
Q

Acute ACS Management

What do you give at SAAS level?

A
  • Aspirin
  • O2 if sats <94%
  • nitrates
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2
Q

Why don’t we give O2 to everyone with ACS?

A

AVOID Study:

If sats >94% infarcts are BIGGER and MORE RECURRENT INFARCTS

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3
Q

Cardiac Biomarkers:
Myoglobin

Rise?
Peak?
Normalises?

A

Rises: 1-2 hours
Peaks: 6-8 hours
Normalises: 1-2 days

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4
Q

Cardiac Biomarkers:
CKMB

Rise?
Peak?
Normalises?

A

Rises: 2-6 hours
Peaks: 16-20 hours
Normalises: 2-3 days

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5
Q

Cardiac Biomarkers:
CK

Rise?
Peak?
Normalises?

A

Rises: 4-8 hours
Peaks: 16-24 hours
Normalises: 3-4 days

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6
Q

Cardiac Biomarkers:
Trop T

Rise?
Peak?
Normalises?

A

Rises: 4-6 hours
Peaks: 12-24 hours
Normalises: 7-10 days

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7
Q

Cardiac Biomarkers:
AST

Rise?
Peak?
Normalises?

A

Rises: 12-24 hours
Peaks: 36-48hrs
Normalises: 3-4 hours

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8
Q

Cardiac Biomarkers:
LDH

Rise?
Peak?
Normalises?

A

Rises: 24-48hrs
Peaks: 72hours
Normalises: 8-10 days

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9
Q

Of the cardiac biomarkers what order do they appear?

A 
Myoglobin
CKMB
CK and Troponin
AST
LDH
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10
Q

STEMI presents WITHIN 12 hours of symptoms

What management?

A

PCI within 90 minutes!!

BUT if you can’t, then give fibrinolysis

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11
Q

Given fibrinolysis in a non-PCI hospital. Should we transfer?

A

Transfer to PCI capable hospital within 24 hours to get either angiography or PCI

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12
Q

Given fibrinolysis in a non-PCI hospital, when would we transfer IMMEDIATELY?

A
  • haemodynamic instability

- <50% ST recovery by 60-90 minutes

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13
Q

What is the PharmacoIntemsive approach to STEMI? What benefits?

A

In HIGH RISK STEMI within 12 hours of symptoms then give FULL DOSE THROMBOLYSIS followed by PCI within 3-24 hours

Benefits:

  • lower infarction rates
  • lower recurrent ischaemia
  • lower 1yr composite endpoints

BUT more intracranial haemorrhage than just PCI and POTENTIALLY JUST AS EFFECTIVE AS PCI ALONE

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14
Q

How many people don’t reperfuse when given thrombolysis?

A

30%

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15
Q

Absolute contradictions to thrombolysis?

A

1) Any previous ICH
2) Known cerebral AVM
3) Ischaemic stroke within past 3 months
4) Active bleeding or bleeding diathesis
5) significant closed head or facial trauma within last 3 months
6) suspected aortic dissection

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16
Q

When should you repeat the ECG after thrombolysis and what should you look for?

Study These Flashcards
A

At 90 minutes

If there is <=50% ST resolution then NEED IMMEDIATE PCI

17
Q

Indication for thrombectomy in STEMI?

Study These Flashcards
A

Do NOT do thrombectomy as NO BENEFIT and INCREASED STROKE

18
Q

Culprit versus Complete Revascularisation?

Study These Flashcards
A

Treat culprit at a later date.

DO NOT open a totally occluded artery in 1 or 2 vessel disease if >24 hours post STEMI

19
Q

When is a CABG superior to PCI?

Study These Flashcards
A
  • 3 vessel disease
  • Left Main Disease
  • diabetes and >1 vessel disease
20
Q

Benefits of radial access in STEMI compared to femoral access?

Study These Flashcards
A
  • lower composite MI/death/stroke
  • decreased overall MORTALITY
  • decreased bleeding
  • decreased length of stay
  • less painful
21
Q

Risks of radial access in STEMI compared to femoral access?

Study These Flashcards
A
  • longer

- more contrast

22
Q

At what sized infarct is there a significantly higher rate of death or heart failure?

Study These Flashcards
A

Infarct size >17%

23
Q

Complications post STEMI: What is the impact of arrythmia <24 hours post STEMI

Study These Flashcards
A

NO IMPACT on PROGNOSIS if ventricular arrythmia in first 24 hours

24
Q

Complications post STEMI: What is the impact of recurrent ventricular arrythmia >24 hours post STEMI

Study These Flashcards
A
  • Indicate larger infarcts

- Higher short AND long term mortality

25
Complications post STEMI: Role of lidocaine in arrythmias?
Lidocaine reduces INCIDENCE of VT BUT not mortality! AND predisposes to asystole and bradycardia
26
Complications post STEMI: RV infarct results in what pathophysiological impact? How do you manage initially to avoid shock?
Decreased pulmonary blood flow and LA repair Results in decreased preload and impaired LV filling Treatment: - reperfusion - aggressive IVT - Inotropes until RV function improves (usually 2-3 days)
27
Complications post STEMI: Ventricular Septal Defect ? when do they occur ? signs ? management
HIGH MORTALITY!! Occur 3-7 days post MI Signs: new HD compromise and new HOLOSYSTOLIC MURMUR Treat with vasopressors and intra-aortic balloon pump
28
Complications post STEMI: Mitral regurgitation ? most common after which type of infarct ? when do they usually occur
More common post INFERIOR-POSTERIOR INFARCTION | If due to papillary muscle rupture then usually 3-7 days post MI
29
Complications post STEMI: LV Free Wall Rupture ? most common after which type of infarct ? when do they occur ? commonly present with what
HIGH MORTALITY More common post ANTERIOR MI Occur 3-7 days post MI Often present with pericardial tamponade, PEA and death
30
Complications post STEMI: LV Thrombus ? most common after which type of infarct ? treatment
More common post ANTERIOR MI | Treat with warfarin 3-6 months
31
What is the use of TIMI score in NSTEMI?
If score 0-2 then use ischaemia guided strategy. Only use invasive if medical fails.
32
Components of TIMI score in NSTEMI?
- Age >65yrs - >3 traditional risk factors - Known CAD with stenosis >50% - Aspirin use in past week - >2 angina episodes in 24 hours - ST deviation >0.5mm - Elevated cardiac biomarkers (CKMB/Troponin)
33
When is an AICD indicated post ACS?
AICD indicated if LVEF <35% at 40 days post MI
34
Which CLINICAL factors increase risk of stent thrombosis? (7)
- Age >80yrs - ACS indication for stent insertion - Diabetes - Renal impairment - Low EF - Previous brachytherapy - Previous stent thrombosis
35
Which ANATOMICAL factors increase risk of stent thrombosis? (6)
- bifurcation stenting - ostial stenting - left main stem stenting - small (<3mm) stent - long (>18mm) stent - multiple stents
36
Which surgeries have an UNACCEPTABLE risk of bleeding?
- intracranial - spinal - eye - TURP - plastic reconstructive
37
How long to defer elective non-cardiac surgery post stenting
Post BMS: Defer >6 weeks (ideally 3 months) | Post DES: Defer 12 months
38
Poor Prognostic Features post ACS
- Age - Hx of heart failure - Peripheral vascular disease - Reduced systolic BP - Killip Class - Initial serum Cr - Initial cardiac biomarker elevation - Cardiac arrest on admission - ST segment deviation
39
Killip Class post ACS
Increased mortality with increased class Killip 1: No clinical signs of heart failure Killip 2: Crackles / S3 Killip 3: Frank APO Killip 4: Cardiogenic shock

RACP Written 2018 (167 decks)

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