Mr S - severe chest pain

Question 1

What are the 4 conditions coming under acute coronary syndrome

Answer 1

N-STEMI
STEMI
unstable angina
posterior infarcts

Question 2

A young adult female with severe chest pain is likely to be suffering from (3)

Answer 2

1. PE
2. Pneumothorax (++ if tall&thin)
3. Cocaine-induced coronary spasm

Question 3

signs of systemic artherosclerotic vascular disease: (5)

Answer 3

1. weak pulses
2. peripheral cyanosis
3. atrophic skin
4. ulcers
5. bruits on auscultation of carotids

Question 4

signs of hypercholesterolaemia (3)

Answer 4

1. xanothmata on bony prominences e.g. elbow
2. xanthelasma around the eye
3. corneal arcus (normal in elderly)

Question 5

how does anaemia relate to prognosis for ischaemic heart disease?

Answer 5

anaemia can cause or exacerbate IHD

Question 6

signs of anaemia (4)

NETL

Answer 6

Eyes - conjuctival pallor
Tongue -glossitis
lips - angular stomatitis
nails - koilonychia

Question 7

what happens to the pulses of the arms in aortic dissectiom?

Answer 7

disappears in one arm

Question 8

blood pressure features in aortic dissection (3)

Answer 8

1. Hypertension (50% people)
2. hypotension (25% of people)
3. BP difference >20mmHg between the arms

Question 9

Why does aortic regurgitation begin in aortic dissection?

Answer 9

the new lumen tracking down into the valve, making it incompetent

Question 10

Criteria for diagnosing a PE?

Answer 10

WELLS criteria

Question 11

where is Boerhaave’s perforation located?

Answer 11

the oesophagus - causes by high esophageal pressure and low intrathoracic pressure (E.g .strained vomiting)

Question 12

Benefits of troponin vs CK-MB for assessing cardiac damage?

Answer 12

troponin is more sensitive + specific to cardiac muscle

Question 13

Drawbacks of troponin vs CK-MB for assessing cardiac damage?

Answer 13

Troponin has an 8 hour delay that CK-MB doesn’t

Question 14

What does elevated CK_MB levels >4days after an MI suggest?

Answer 14

reinfarction, as CK_MB levels go back to normal in 2/3 days (troponin high for >7days)

Question 15

blood tests for cardiac disease (6)

Answer 15

1. Troponin - (at time of event then 12 hours after onset)
2. serum cholesterol
3. FBC - anaemia will cause/exacerbate deficiency in cardiac perfusion
4. Urea and electrolytes - (K+ importnat as can cause arrhythmia)
5. Inflammatory markers (CRP, ESR, WCC)
6. capillary glucose

Question 16

how are D dimer levels useful for diagnosing PE?

Answer 16

Not useful for diagnosing, as high levels could be caused by fibrin breakdown anywhere. However, low D-dimer can rule out DVT/PE.

Question 17

What is ST depression in leads V1-V3 consistent with?

Answer 17

anterior NSTEMI
could represent posterior infarct de to the ECG leads being on the opposite sides of the chest wall (for a transmural infarct)

Question 18

ultimate source for diagnosing MI?

Answer 18

elevated 12 hour troponin

Question 19

pneumonic for drugs given for acute coronary syndrome

Answer 19

MONABASH

Question 20

What does MONABASH stand for?

Answer 20

Morphine
Oxygen
Nitrates
Antiplatelets
Betablockers
Ace inhibitors
Statins
Heparin *LMWH

Question 21

What treatment should be provided to patients with STEMI within 12 hours (ideally 2) of the onset of their pain.

Answer 21

angioplasty/thrombolysis

angioplasty is better, but whichever can be delivered quicker will do

Question 22

When do NSTEMI patients receive thrombolysis?

Answer 22

when their TIMI score >=3