ACS

• What is acute coronary syndrome?

  It is a spectrum of conditions resulting from thrombus formation in coronary arteries.
• What are the conditions included in acute coronary syndrome?

  Unstable angina, non-ST elevation myocardial infarction, and ST elevation myocardial infarction.
• How is the heart supplied with blood?

  Through the coronary arteries connected to the aorta near the aortic valve.
• When are the coronary arteries perfused?

  During diastole when blood backflows to the aortic valve.
• What are the two main coronary arteries?

  The left coronary artery and the right coronary artery.
• What does the left coronary artery divide into?

  The left anterior descending artery, left marginal artery, and circumflex artery.
• What does the left anterior descending artery supply?

  The left ventricle and interventricular septum, as well as some of the right ventricle.
• What does the right coronary artery supply?

  The right atrium, including the SA and AV nodes, and the right ventricle.
• What is atherosclerosis?

  The formation of fatty plaques on the walls of arteries.
• What is contained in atherosclerotic plaques?

  A fibrous cap with cell debris, lipids, and inflammatory cells.
• What happens in stable angina?

  It is a slow change over time due to narrowed arteries.
• What can happen if atherosclerotic plaques narrow the vessel lumen?

  It can lead to ischemia, especially during increased demand like exercise.
• What occurs during acute coronary syndrome?

  Plaques rupture, exposing thrombogenic material and leading to clot formation.
• What characterizes unstable angina?

  Myocytes are ischemic but not yet necrosed, with no cell death.
• What distinguishes non-ST elevation myocardial infarction from ST elevation myocardial infarction?

  STEMI has complete occlusion and transmural necrosis, while NSTEMI does not.
• What are some non-modifiable risk factors for acute coronary syndrome?

  Age, male sex, family history, and ethnicity.
• What does the ST segment elevation indicate in STEMI?

  It indicates a complete occlusion of the coronary artery.
• What are the risk factors for acute coronary syndrome?

  They are divided into modifiable and non-modifiable factors.
• What are some modifiable risk factors for acute coronary syndrome?

  Smoking, hypertension, diabetes, hyperlipidemia, obesity, and drug use.
• How may acute coronary syndrome present differently in women?

  Women may present without chest pain, leading to more subtle symptoms.
• What is a key part of the diagnosis for acute coronary syndrome?

  An ECG is essential for diagnosis.
• What are common symptoms of acute coronary syndrome?

  Chest pain, upper back pain, epigastric pain, lightheadedness, and nausea.
• What indicates STEMI on an ECG?

  Elevations in the ST segment in two contiguous leads of at least one millimeter.
• What is the significance of a new left bundle branch block in STEMI diagnosis?

  It is included in the criteria for diagnosing STEMI.
• What do leads V1 to V4 represent on an ECG?

  They are known as anterior or septal leads representing the left anterior descending artery.
• What do leads 2, 3, and aVF represent on an ECG?

  They are the inferior leads showing part of the right coronary artery or left circumflex artery.
• What is indicated by reciprocal ST depressions in opposite leads?

  They may be the only findings in posterior STEMI.
• What is the hallmark of non-ST elevation acute coronary syndrome?

  ST depressions and T-wave inversions.
• What do T-wave inversions alongside ST segment changes indicate?

  They indicate ongoing ischemia.
• What is the primary lab investigation for acute coronary syndrome?

  Cardiac troponin I assays.
• When do cardiac troponin I levels typically rise after chest pain onset?

  They rise from 2 hours after the onset of chest pain.
• How long can cardiac troponin I levels remain elevated?

  They can remain elevated for between 4 and 15 days.
• What is the definitive investigation for acute coronary syndrome?

  Coronary angiography.
• What is the role of a chest X-ray in acute coronary syndrome?

  It can reveal pulmonary edema or cardiomegaly but is not directly involved in the workup.
• What is the general management for acute coronary syndrome?

  Includes analgesia, oxygen therapy, nitrates, and aspirin.
• What is the mnemonic for the medications used in acute coronary syndrome management?

  MONA (Morphine, Oxygen, Nitrates, Aspirin).
• What is the preferred treatment for STEMI patients?

  Reperfusion therapy as early as possible if chest pain onset was within 12 hours.
• What is primary percutaneous coronary intervention?

  It involves inserting a balloon and stent into the clogged coronary artery.
• What is fibrinolytic therapy used for?

  It involves the use of tissue plasminogen activators when PCI is not feasible.
• What additional medications are used for confirmed STEMI and NSTEMI?

  Additional anti-platelets like P2Y12 inhibitors and anticoagulation.