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Flashcards in Acute Coronary Syndromes Deck (11)
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1

Describe the common symptoms of ischaemic chest pain

Usually central

Radiation (not always present) to inner left arm, (also sometimes abdomen, neck)

Crushing, band-like, heavy

Duration: remits with rest if exerton related

Exacerbating factors: exercise, stress, tachycardia

Relieving factors: rest, GTN 

2

What features may be seen on examination in a patient with ischaemic chest pain?

If symptoms have settled, examination often normal.

Can exhibit:

  • Pallor
  • Hypotension
  • Tachycardia
  • Diaphoresis
  • Cold/clammy skin
  • Central or peripheral cyanosis, low SpO2
  • Bibasal crackles (left ventricular failure)
  • Raised JVP (right ventricular failure)
  • Hepatomegaly (right ventricular) 
  • Pedal lower limb and sacral oedema (right ventricular failure) 
  • Mitration regurgitation (3rd and 4th heart sounds) (damage to papillary muscles)

3

What are the main differences between unstable angina, NSTEMI and STEMI?

Unstable Angina:

  • Clinical entity (no pathological damage to cardiac muscle)
  • Pain at rest or with minimal exertion
  • No major ECG changes, changes may be non-specific 
  • Troponin normal
  • No infarction, does not involve necrosis 

NSTEMI:

  • Clino-pathological entity
  • Ischaemic damage to cardiac muscle, subendocardial not transmural
    • ECG changes often show ST depression +/- T-wave inversion
    • ECG changes may be non-specific
  • History may be similar to UA 
  • Troponin rises then falls 

STEMI:

  • Infarction and necrosis of cardiac muscle, often transmural
  • Persistent ST-elevation on ECG 
  • Troponin raised 
  • Symptoms more severe than NSTEMI or UA

4

What potential consequences are associated with acute coronary syndromes?

  • Hypotension
  • Cardiogenic shock
  • AKI
  • Tachyarrhythmias
  • Bradyarrhythmias
  • Conduction defects
  • Pericarditis
  • Ventricular aneurysm
  • Cardiac rupture
  • Mural thrombosis
  • Post MI (Dressler's) syndrome 

5

What else can cause a raised troponin?

 

Renal failure

In the absence of other causes however it is highly specific and sensitive to ischaemic myocardial damage. 

6

Describe the phases of acute MI

Ischaemic phase (acute phase):

  • Myocardium survives on anaerobic metabolism initially

Infarction phase:

  • Anaerobic metabolism cannot keep up with metabolic demand- irreversible damage and cell death occur 

7

What are pathological Q waves associated with?

Infarction 

  • NSTEMI or STEMI 

8

What would ST elevation in V1-V6 indicate?

V1-V2: Septal

V3-V4: Anterior/septal 

V5-V6: Lateral 

 

(V1-V4 extensive anterior)

9

What is used in primary and secondary prevention of ACS?

Statins

B-blockers

ACE-Inhibitors

Aspirin/Clopidogrel

Smoking cessation

Diet

Exercise

 

10

What is used in the treatment of ACS?

  • Oxygen
  • Aspirin/clopidogrel
  • LMWH
  • Opiates
  • Nitrates
  • Thrombolytics
  • B-blockers
  • PCI
  • CABG

11

What is used to treat the complications associated with ACS?

  • Anti-arrhythmics
  • Percutaneous, temporary and permanent pacemakers,
  • Ionotropes
  • Diuretics
  • Intra-aortic balloon pump
  • Adrenalin
  • Atropine