p.28
Diagnosis and Investigations for ACS
What lab tests are important in the assessment of heart failure?
BNP, cardiac biomarkers, and ABG.
p.24
Diagnosis and Investigations for ACS
What is the purpose of an echocardiogram in heart failure diagnosis?
To determine the ejection fraction, assess valvular pathology, check for dilated inferior vena cava, and identify regional wall motion abnormalities.
p.16
Diagnosis and Investigations for ACS
What factors does the TIMI score take into account?
Age, risk factors (e.g., hypercholesterolaemia, diabetes), ECG changes, angina events, and cardiac biomarkers.
p.4
Diagnosis and Investigations for ACS
Why is it essential to integrate ECG findings in Type 1 myocardial infarction?
To classify Type 1 MI into STEMI or NSTEMI and establish the appropriate treatment.
p.13
Complications Associated with ACS
What should be observed for in patients with inferior MI affecting the right ventricle?
Evidence of ventricular failure.
p.17
Management Strategies for ACS
What should a management plan for acute heart failure consider?
The severity of presentation.
p.13
Management Strategies for ACS
What is the treatment for acute left ventricular decompensation?
IV diuresis, nitrates, or CPAP.
p.27
Management Strategies for ACS
What is the primary benefit of ICDs?
They reduce the risk of sudden cardiac death.
p.4
Types of Myocardial Infarction
How can plaque rupture complicate Type 1 myocardial infarction?
Plaque rupture may be complicated by intraluminal thrombosis and hemorrhage into the plaque, exacerbating the thrombosis.
p.1
Clinical Features and Symptoms of ACS
What is a common description of pain associated with ACS?
Vise-like, constricting, crushing weight and/or pressure.
p.13
Management Strategies for ACS
Which medications may be considered for rate control or anti-arrhythmic purposes?
B blockers or amiodarone.
p.30
Acute Coronary Syndrome (ACS) Overview
What is the primary focus of cardiology?
The study and treatment of heart conditions and diseases.
p.10
Diagnosis and Investigations for ACS
What happens to cTn values after acute myocardial injury?
cTn values rise from below to above the 99th percentile.
p.21
Clinical Features and Symptoms of ACS
What does raised JVP indicate?
Elevated secondary to right heart failure and fluid overload.
p.17
Clinical Features and Symptoms of ACS
What is a key aspect to distinguish between left and right heart failure?
Their clinical presentations and aetiologies.
p.24
Diagnosis and Investigations for ACS
What can chest X-ray (CXR) indicate in heart failure?
It can show pleural effusion and other signs of heart failure.
What are the short-term outcomes for NSTEMI compared to STEMI?
Short-term NSTEMI outcomes are better than STEMI.
p.9
Diagnosis and Investigations for ACS
What is the purpose of a transthoracic echocardiogram (TTE) in diagnosing acute coronary syndrome?
To evaluate atrial and ventricular size and function, detect valvular heart disease, left ventricular hypertrophy, pericardial disease, and estimate right ventricular systolic pressure.
p.25
Management Strategies for ACS
What are some key prevention strategies for heart failure?
Reduce cholesterol, reduce blood pressure, stop smoking, reduce alcohol intake, maintain a healthy BMI, and strict glycaemic control if diabetic.
p.17
Clinical Features and Symptoms of ACS
What are the two types of heart failure?
Left heart failure and right heart failure.
p.21
Clinical Features and Symptoms of ACS
What is peripheral oedema a sign of?
Right heart failure and fluid overload.
p.10
Diagnosis and Investigations for ACS
What does a declining delta in cTn values indicate?
It suggests very late sampling after myocardial injury.
p.25
Management Strategies for ACS
What initial treatment should be administered for suspected acute decompensated heart failure (ADHF)?
Oxygen to maintain oxygen saturation above 95%.
p.30
Types of Myocardial Infarction
What are the types of myocardial infarction?
ST-elevation myocardial infarction (STEMI) and non-ST elevation myocardial infarction (NSTEMI).
p.27
Management Strategies for ACS
What is the indication for considering LVAD therapy or transplant?
Patients with NYHA Stage IV heart failure failing therapy with intractable symptoms.
p.12
Management Strategies for ACS
What should be considered if PCI cannot be performed within 120 minutes?
Thrombolysis can be administered if no contraindications are present and symptom onset is within 12 hours.
p.14
Clinical Features and Symptoms of ACS
What is a key component of initial assessment in acute ACS management?
Airway, circulation, and assessment for hypovolemic shock.
p.24
Diagnosis and Investigations for ACS
What does a cardiac MRI assess in heart failure?
It is the gold standard for assessing ventricular dysfunction and can help determine ischaemic or non-ischaemic cardiomyopathies.
p.13
Management Strategies for ACS
What should be considered for patients with SBP greater than 90 mmHg?
GTN spray sub-lingual/patch or IV infusion.
p.17
Differential Diagnosis of ACS
What is important to formulate based on clinical history and exam in heart failure?
An appropriate list of differential diagnosis.
p.9
Diagnosis and Investigations for ACS
Why are ECG findings important in diagnosing acute coronary syndrome?
They provide key diagnostic information.
p.30
ECG Interpretation in ACS
What is the significance of ECG in cardiology?
It helps in diagnosing heart rhythm abnormalities and ischemia.
p.26
Management Strategies for ACS
What are the two factors that pharmacological interventions for heart failure are based on?
The patient's Ejection Fraction (HFpEF or HFrEF) and whether they are symptomatic or asymptomatic.
p.2
Types of Myocardial Infarction
What is the definition of a Type 1 Myocardial Infarction?
Detection of a rise and/or fall of Troponin with at least one value above the 99th percentile upper reference limit and at least one of the following: symptoms of acute myocardial ischemia, new ischemic ECG changes, development of pathological Q waves, imaging evidence of new loss of viable myocardium, or identification of a coronary thrombus.
p.6
Clinical Features and Symptoms of ACS
What should be commented on regarding tachycardia?
Rate, rhythm, character, and volume.
p.4
Types of Myocardial Infarction
What is the primary cause of Type 1 myocardial infarction?
Athero-thrombotic coronary artery disease, usually precipitated by atherosclerotic plaque disruption.
p.17
Epidemiology and Risk Factors for ACS
What should be identified as key clinical features of heart failure?
Risk factors for heart failure.
p.10
Diagnosis and Investigations for ACS
What is the significance of the 99th percentile in cTn values?
cTn values above the 99th percentile indicate acute myocardial infarction.
p.17
Diagnosis and Investigations for ACS
What is necessary to establish the diagnosis, severity, and complications of heart failure?
An appropriate investigation plan.
p.28
Clinical Features and Symptoms of ACS
What key factors should be assessed from the patient's history in heart failure?
Dyspnea and fluid overload.
p.25
Management Strategies for ACS
What is the recommended action regarding intravenous (IV) loop diuretics in acute heart failure management?
Check blood pressure is not low (<100 mmHg) as this may worsen the condition.
p.25
Management Strategies for ACS
What should be considered if a patient continues to desaturate during acute heart failure treatment?
Consider CPAP (Continuous Positive Airway Pressure).
p.24
Diagnosis and Investigations for ACS
What can an electrocardiogram (ECG) reveal in heart failure patients?
It can determine if there is any arrhythmia or ST elevation/depression.
p.28
Management Strategies for ACS
What is the initial management for acute decompensated heart failure?
IV loop diuretics (Furosemide 40-60mg; caution if hypotensive), analgesia, GTN infusion, monitor fluid balance, consider CPAP, and referral to ICU for inotropes if severely hypotensive.
p.1
Clinical Features and Symptoms of ACS
What is the significance of recognizing specific clinical features in ACS?
It helps in assessing the severity of the condition.
p.30
Clinical Features and Symptoms of ACS
What are common symptoms of heart disease?
Chest pain, shortness of breath, fatigue, and palpitations.
p.9
Diagnosis and Investigations for ACS
What can a TTE identify in relation to heart function?
A regional wall motion abnormality.
p.1
Management Strategies for ACS
What should be constructed for managing ACS?
An appropriate acute and long-term management plan considering complications and prevention.
p.12
Management Strategies for ACS
What is the time frame for performing PCI for patients arriving at a non-PCI capable hospital?
Within 120 minutes or less.
p.8
Diagnosis and Investigations for ACS
What does a decrease in hemoglobin suggest in patients with acute coronary syndrome?
It suggests anemia, which can drive demand ischemia.
p.30
Epidemiology and Risk Factors for ACS
What are some risk factors for cardiovascular disease?
Hypertension, diabetes, smoking, and high cholesterol.
p.20
Clinical Features and Symptoms of ACS
What type of cough may indicate heart failure?
A productive cough, particularly of pink frothy sputum.
p.2
Diagnosis and Investigations for ACS
What role does the ECG play in diagnosing myocardial infarction?
It is a key investigation to determine the diagnosis and decide the immediate management of either STEMI or NSTEMI.
p.16
Diagnosis and Investigations for ACS
What does the TIMI score predict?
Outcomes for those with unstable angina/NSTEMI.
p.24
Diagnosis and Investigations for ACS
What does the mnemonic A-B-C-D-E help recall in heart failure radiological findings?
A - Alveolar Oedema, B - Kerley B Lines, C - Cardiomegaly, D - Diversion of upper lobe vessels, E - Pleural Effusion.
p.14
Management Strategies for ACS
What is the initial management for ST Elevation Myocardial Infarction (STEMI)?
Urgent revascularisation.
p.20
Clinical Features and Symptoms of ACS
What is orthopnoea?
Difficulty in lying flat due to fluid overload, causing shortness of breath.
p.10
Diagnosis and Investigations for ACS
What is the importance of sampling time in relation to cTn values?
Early sampling can show rising cTn values, while very late sampling may show declining values.
p.7
Epidemiology and Risk Factors for ACS
What is the relationship between hypertension and ACS?
Hypertension is a risk factor for ACS.
p.5
Clinical Features and Symptoms of ACS
What does the acronym SOCRATES stand for in assessing chest pain?
It refers to the characteristics of the pain: Site, Onset, Character, Radiation, Associated symptoms, Time course, and Exacerbating/relieving factors.
p.21
Clinical Features and Symptoms of ACS
What does a displaced apex beat indicate?
May be secondary to left ventricular hypertrophy (LVH).
p.26
Management Strategies for ACS
What is the role of diuretics in symptomatic patients with HFpEF?
Used for symptomatic relief.
p.5
Clinical Features and Symptoms of ACS
What does orthopnoea indicate in a patient with suspected ACS?
Difficulty lying flat and increased breathlessness, which are indicators of more severe disease.
p.13
Management Strategies for ACS
What is the recommended oxygen administration for patients with SaO2 levels above 90%?
Routine oxygen is not recommended.
p.1
Clinical Features and Symptoms of ACS
What are some other manifestations of myocardial ischemia?
Weakness, collapse, coma, nausea, vomiting, shortness of breath, and anxiety.
p.10
Diagnosis and Investigations for ACS
What is the challenge with low cTn values?
They are hard to detect and may not indicate myocardial injury.
p.22
Epidemiology and Risk Factors for ACS
What are some cardiovascular risk factors for heart failure?
Previous MI, arrhythmia, valvular pathology, and hypertension.
p.13
Management Strategies for ACS
What should be managed if a patient is hypotensive?
Blood pressure; severe cases may benefit from inotropes, intra-aortic balloon pump, or left ventricular assist device.
p.5
Clinical Features and Symptoms of ACS
What is a common characteristic of chest pain in Acute Coronary Syndrome?
Generally acute central crushing chest pain that lasts several minutes.
p.2
Clinical Features and Symptoms of ACS
What symptoms are associated with acute myocardial ischemia?
Central crushing chest pain for several minutes.
p.18
Clinical Features and Symptoms of ACS
What are common symptoms of Heart Failure?
Breathlessness, fatigue, orthopnea, and paroxysmal nocturnal dyspnea (PND).
p.8
Diagnosis and Investigations for ACS
What do cardiac biomarkers like troponin and CKMB indicate?
A rise in cardiac biomarkers is a sign of ischemia.
p.23
Diagnosis and Investigations for ACS
What is the diagnostic test of choice for heart failure?
CTPA (Computed Tomography Pulmonary Angiography).
p.3
Epidemiology and Risk Factors for ACS
What demographic shift occurs in ACS patients after the age of 75?
Women represent the majority of patients with ACS.
p.11
Diagnosis and Investigations for ACS
What should be evaluated in a repeat ECG for a patient with suspected ACS?
New arrhythmias, heart blocks secondary to ischemia, and broad complex tachycardia.
p.21
Clinical Features and Symptoms of ACS
What does peripheral cyanosis indicate?
Congestive heart failure (CCF).
p.4
Types of Myocardial Infarction
What role does thrombosis play in Type 1 myocardial infarction?
The dynamic thrombotic component leads to distal coronary embolization resulting in myocyte necrosis.
p.1
Clinical Features and Symptoms of ACS
What are the key clinical features of Acute Coronary Syndrome (ACS)?
Retrosternal pain, radiating to the left shoulder, ulnar aspect of the left arm, neck, jaw, teeth, back, abdomen, or right arm.
p.24
Diagnosis and Investigations for ACS
Why are blood investigations important in heart failure management?
To check for complications such as renal failure associated with medication and renal hypoperfusion.
p.10
Diagnosis and Investigations for ACS
What does Cardiac Troponin (cTn) indicate in the context of myocardial injury?
It is a biomarker used to diagnose acute myocardial infarction and chronic myocardial injury.
p.4
Diagnosis and Investigations for ACS
What are the two classifications of Type 1 myocardial infarction based on ECG findings?
STEMI (ST-Elevation Myocardial Infarction) and NSTEMI (Non-ST-Elevation Myocardial Infarction).
p.20
Clinical Features and Symptoms of ACS
What is a common symptom of heart failure related to breathing?
Shortness of breath (SOB), which may develop insidiously over time.
p.20
Clinical Features and Symptoms of ACS
What does NYHA stand for in the context of heart failure?
New York Heart Association, which classifies the severity of heart failure symptoms.
p.30
Diagnosis and Investigations for ACS
What diagnostic tests are commonly used in cardiology?
Electrocardiograms (ECG), echocardiograms, and stress tests.
p.17
Long-term Management and Prevention of ACS
What are the two types of long-term management for heart failure?
Pharmacological and non-pharmacological.
p.6
Clinical Features and Symptoms of ACS
What does peripheral cyanosis indicate in the context of ACS?
Evidence of congestive heart failure (CCF).
p.20
Clinical Features and Symptoms of ACS
What is paroxysmal nocturnal dyspnoea (PND)?
Gasping for air in the middle of the night due to fluid redistribution.
p.26
Management Strategies for ACS
What is recommended for asymptomatic patients with HFpEF?
No specific pharmacotherapy, but close monitoring and follow-up with echocardiograms.
p.25
Management Strategies for ACS
What is the purpose of a urinary catheter in acute heart failure management?
To monitor strict hourly urine output.
p.26
Management Strategies for ACS
What pharmacological treatment is recommended for asymptomatic patients with HFrEF who have a history of MI?
ACE inhibitor and Beta-blocker.
p.18
Clinical Features and Symptoms of ACS
What signs may accompany Heart Failure?
Elevated jugular venous pressure, hepato-jugular reflux, pulmonary crackles, peripheral edema, weight gain, and a third heart sound.
p.20
Clinical Features and Symptoms of ACS
What is a common symptom related to weight in heart failure patients?
Weight gain, particularly around the central abdomen, generally not associated with increased appetite.
p.30
Long-term Management and Prevention of ACS
What is important for long-term management of heart disease?
Regular follow-ups, medication adherence, and lifestyle modifications.
p.19
Clinical Features and Symptoms of ACS
What are the symptoms of NYHA Class II heart failure?
Comfortable at rest, mild symptoms only with normal activity.
p.11
Long-term Management and Prevention of ACS
What is the importance of tight glycemic control in diabetic patients with ACS?
It helps in the prevention and management of complications.
p.29
Management Strategies for Heart Failure
What was the outcome of the SOLVD Trial regarding Enalapril?
It reduced incidence and hospitalization for congestive heart failure in asymptomatic LV dysfunction.
p.23
Epidemiology and Risk Factors for ACS
What are risk factors for developing heart failure?
Hypercholesterolaemia and diabetes.
p.28
Management Strategies for ACS
What should be done for initial resuscitation in acute heart failure?
Establish IV access with 2x wide bore cannulae, sit the patient upright, provide supplemental oxygen to maintain >95%, and insert a urinary catheter.
p.20
Clinical Features and Symptoms of ACS
What should be included in the history of presenting complaint for heart failure?
Risk factors, particularly previous cardiac events.
What are the long-term outcomes for NSTEMI compared to STEMI?
Long-term outcomes for NSTEMI are equal to those for STEMI.
p.1
Diagnosis and Investigations for ACS
What should be outlined to establish diagnosis and risk factors in ACS?
Appropriate investigations.
p.12
Management Strategies for ACS
What is the aim for performing PCI in patients transported to a PCI capable hospital?
Within 90 minutes or less.
p.3
Epidemiology and Risk Factors for ACS
What is the trend in the incidence of STEMI and NSTEMI?
The incidence of STEMI is decreasing, while the incidence of NSTEMI is increasing.
p.10
ECG Interpretation in ACS
What do ECG leads correspond to in the context of myocardial injury?
They correspond to specific areas of the heart affected by ischemia.
p.18
Clinical Features and Symptoms of ACS
What is Heart Failure (HF)?
A clinical syndrome characterized by symptoms like breathlessness and fatigue, accompanied by signs such as elevated jugular venous pressure and pulmonary crackles.
p.6
Clinical Features and Symptoms of ACS
What does raised JVP indicate?
May be elevated secondary to right heart failure and fluid overload.
p.7
ECG Interpretation in ACS
What does the S1Q3T3 pattern on an ECG suggest?
Right heart strain, often associated with pulmonary embolism.
p.11
Complications Associated with ACS
What are the most serious mechanical complications of myocardial infarction?
Acute mitral regurgitation, acute ventricular septal defect, and acute left ventricular free wall rupture.
p.6
Clinical Features and Symptoms of ACS
What does a gallop rhythm (S3) indicate?
Associated with rapid ventricular filling.
p.9
Diagnosis and Investigations for ACS
What other ECG findings may indicate acute coronary syndrome?
ST depression, evidence of arrhythmia, and new bundle branch blocks.
p.23
Clinical Features and Symptoms of ACS
What are common symptoms of pneumothorax?
Acute onset shortness of breath (SOB) and pleuritic chest pain.
p.15
Long-term Management and Prevention of ACS
What is the focus of the MDT approach in long-term management of Acute Coronary Syndrome?
Cardiac rehabilitation including input from various specialists.
p.2
Diagnosis and Investigations for ACS
What is the significance of a Troponin rise in myocardial infarction?
It indicates myocardial injury and is a key diagnostic criterion.
p.21
Clinical Features and Symptoms of ACS
What should be checked if a midline sternotomy scar is present?
Look for a vein harvesting scar to determine if the likely indication was a CABG.
p.2
ECG Interpretation in ACS
What ECG changes are associated with STEMI?
ST elevation or new left bundle branch block (LBBB).
p.26
Management Strategies for ACS
What is the effect of diuretics on hospitalization and mortality in HFrEF?
Diuretics reduce the risk of hospitalization and improve symptoms but do not reduce mortality.
p.5
Clinical Features and Symptoms of ACS
What should be asked about palpitations in the context of ACS?
Onset, duration, and rhythm of the heart beating.
p.21
Clinical Features and Symptoms of ACS
What does dyspnoea indicate in a heart failure patient?
Shortness of breath and increased oxygen requirement.
p.9
Diagnosis and Investigations for ACS
What does an ECG represent in the context of acute coronary syndrome?
A snapshot in time of the heart's electrical activity.
p.21
Clinical Features and Symptoms of ACS
What does a parasternal heave suggest?
Evidence of right heart strain or failure.
p.14
Management Strategies for ACS
What anticoagulants can be used in acute ACS management?
Unfractionated Heparin (UFH) or Low Molecular Weight Heparin (LMWH).
p.27
Management Strategies for ACS
What is the purpose of LVAD therapy?
It is often used as a 'bridge to transplant'.
p.25
Long-term Management and Prevention of ACS
What non-pharmacological approaches are recommended for chronic heart failure management?
Education regarding heart failure, weight loss, smoking cessation, dietary review, exercise, and addressing contributing pathologies.
p.30
Complications Associated with ACS
What complications can arise from ACS?
Heart failure, arrhythmias, and sudden cardiac arrest.
p.19
Epidemiology and Risk Factors for ACS
What characterizes the population with HFpEF?
More often an older female population with a history of atrial fibrillation and hypertension.
p.23
Clinical Features and Symptoms of ACS
What examination findings are associated with pneumothorax?
Diminished breath sounds and hyperresonance to percussion.
p.3
Types of Myocardial Infarction
What characterizes Type 2 Myocardial Infarction (MI)?
Elevated troponin with an imbalance between myocardial oxygen supply and demand, unrelated to coronary athero-thrombosis.
p.23
Diagnosis and Investigations for ACS
What does an ABG show in cases of pneumothorax?
Type 1 Respiratory failure.
p.15
Long-term Management and Prevention of ACS
What is the role of specialized cardiac nurses in ACS management?
Discussing recognition of symptoms and care.
p.5
Clinical Features and Symptoms of ACS
What is the significance of nausea in ACS presentations?
Generally indicates discomfort, but vomiting is not common; it should still be assessed.
p.3
Types of Myocardial Infarction
What defines Type 5 Myocardial Infarction (MI)?
Related to coronary artery bypass grafting (CABG) with a significant troponin rise (x10 ULN) and evidence of myocardial ischemia.
p.29
Management Strategies for Heart Failure
What did the RALES Study conclude about Spironolactone?
It reduced symptoms and mortality in HFrEF patients.
p.7
Epidemiology and Risk Factors for ACS
What is a significant risk factor for Acute Coronary Syndrome (ACS) related to family history?
Having a first-degree relative with a history of ACS before age 55 in males and 65 in females.
p.27
Management Strategies for ACS
What are the two types of cardiac devices used in selected heart failure patients?
Implantable cardiac defibrillators (ICDs) and cardiac resynchronisation therapy (CRT) devices.
p.21
Clinical Features and Symptoms of ACS
What might scars on the chest indicate during examination?
Evidence of previous CABG or valve replacement.
p.8
Diagnosis and Investigations for ACS
What does an elevated white cell count (WCC) indicate in the context of acute coronary syndrome?
It may indicate infection or lower respiratory tract infection (LRTI).
p.19
Clinical Features and Symptoms of ACS
What is the New York Heart Association (NYHA) classification used for?
To describe the severity of symptoms and exercise intolerance in heart failure.
p.12
Management Strategies for ACS
What is the preferred management time frame for PCI after symptom onset?
Up to 12 hours after onset of symptoms.
p.19
Epidemiology and Risk Factors for ACS
What is the prevalence of heart failure in the adult population of developed countries?
1-2%, rising to over 10% among people over 70 years old.
p.25
Management Strategies for ACS
What are some signs of treatment failure in acute heart failure?
Poor urine output (<0.5 ml/kg/hour), patient tiring on CPAP, and hypotension.
p.21
Clinical Features and Symptoms of ACS
What is the significance of an S3 third heart sound?
It may indicate heart failure.
p.22
Epidemiology and Risk Factors for ACS
What family history is a risk factor for heart failure?
Family history of cardiomyopathy.
p.26
Management Strategies for ACS
What is key to improving outcomes for symptomatic patients with HFpEF?
Caring for these patients within a multidisciplinary disease management program, focusing on co-morbidities.
p.22
Differential Diagnosis of ACS
What ECG findings are associated with acute myocardial infarction?
ST elevation and T Wave inversion.
p.29
Management Strategies for Heart Failure
Which medication reduced the outcome of cardiovascular death or heart failure hospitalization in patients with HFrEF?
Dapagliflozin and Empagliflozin.
p.12
Management Strategies for ACS
What is the recommended treatment if there is evidence of pulmonary edema?
Treat with IV diuretics, ensuring BP is not low (<100 mmHg).
p.12
Management Strategies for ACS
What analgesia is recommended for patients in acute coronary syndrome?
2.5 mg Cyclomorph IV and/or IV paracetamol.
p.23
Diagnosis and Investigations for ACS
Why are serum urea and electrolytes important in heart failure?
To identify underlying imbalances that can cause arrhythmias.
p.23
Diagnosis and Investigations for ACS
What is a key clinical sign in the Wells’ Score for PE?
Clinical signs and symptoms of DVT.
p.28
Clinical Features and Symptoms of ACS
What initial assessments should be made in acute heart failure?
Check for airway compromise, breathing, and signs of hypotension.
p.28
Management Strategies for ACS
What is the role of CPAP in acute decompensated heart failure?
Consider CPAP if there is failure to maintain O2 saturations.
p.27
Management Strategies for ACS
How does CRT therapy improve heart function?
By resynchronizing left ventricular contraction to increase ejection fraction.
p.11
Complications Associated with ACS
What imaging findings might suggest heart failure in a patient with Acute Coronary Syndrome?
Cardiomegaly and pulmonary edema on chest X-ray (CXR).
p.13
Management Strategies for ACS
What should be avoided in patients with anterior/lateral MI affecting the left ventricle?
B blockers and calcium channel blockers.
p.5
Clinical Features and Symptoms of ACS
What symptoms should be explored alongside chest pain?
Feelings of heart racing/palpitations, weakness/dizziness, nausea, shortness of breath, and leg swelling.
p.30
Differential Diagnosis of ACS
What is the differential diagnosis for chest pain?
Myocardial infarction, angina, pulmonary embolism, and aortic dissection.
p.26
Management Strategies for ACS
What are the 'Four pillars of therapy' for symptomatic HFrEF patients?
ACE/ARB/ARNI, Beta-blocker, Mineralocorticoid receptor antagonist (MRA), SGLT2 inhibitor.
p.8
Epidemiology and Risk Factors for ACS
What role do fasting lipids and HbA1c play in acute coronary syndrome?
They are major contributory risk factors in the development of myocardial infarction (MI).
p.22
Differential Diagnosis of ACS
What are the symptoms of pulmonary embolism?
Acute onset SOB, collapse, pre-syncope, and pleuritic chest pain.
p.8
Diagnosis and Investigations for ACS
What is the significance of D-Dimer in acute coronary syndrome?
It is a non-specific investigation but can significantly reduce the probability of alternative diagnoses like pulmonary embolism or aortic dissection if negative.
p.29
Management Strategies for Heart Failure
What did the SCD-HeFT Trial demonstrate about ICDs?
ICDs improved mortality in symptomatic HFrEF patients.
p.11
Complications Associated with ACS
What laboratory findings may indicate infection or Dressler’s syndrome in a patient with Acute Coronary Syndrome?
Increased white cell count (WCC) and increased C-reactive protein (CRP).
p.30
Management Strategies for ACS
What are common management strategies for ACS?
Medications, lifestyle changes, and surgical interventions.
p.6
Clinical Features and Symptoms of ACS
What might scars indicate during a physical examination?
Evidence of previous CABG or ICD, which may inform about possible aetiology.
p.19
Epidemiology and Risk Factors for ACS
What characterizes the population with HFrEF?
More often a younger male population, often with ischaemic/toxic aetiologies.
p.12
Management Strategies for ACS
What should be done if a patient with NSTEMI has ongoing pain despite analgesia?
Consider urgent revascularisation and discuss with cardiology.
p.14
Diagnosis and Investigations for ACS
What laboratory tests should be performed in acute ACS management?
Serial troponin, FBC/CRP, U/E.
p.8
Diagnosis and Investigations for ACS
Why are serum urea and electrolytes tested in acute coronary syndrome?
To assess renal function and determine the appropriate dose of contrast during angiography.
p.7
Epidemiology and Risk Factors for ACS
How does obesity relate to Acute Coronary Syndrome?
Obesity is a recognized risk factor for ACS.
p.26
Management Strategies for ACS
What is the goal for initiating therapy in HFrEF patients?
To commence patients on all four therapies at maximally tolerated doses.
p.22
Differential Diagnosis of ACS
What examination findings are associated with COPD exacerbation?
Wheeze, crepitations, and desaturation.
p.3
Types of Myocardial Infarction
What is Type 4 Myocardial Infarction (MI) associated with?
Percutaneous coronary intervention with a significant troponin rise (x5 ULN) and evidence of myocardial ischemia.
p.29
Management Strategies for Heart Failure
Which trials demonstrated that Candesartan and Valsartan reduced mortality in HFrEF?
CHARM and ValHeFT Trials.
p.18
Pathophysiology and Aetiology
What are some causes of diseased myocardium leading to Heart Failure?
Ischaemic heart disease, toxic damage (e.g., alcohol, chemotherapy), infiltrative diseases (e.g., amyloid), and genetic abnormalities.
p.18
Diagnosis and Investigations for ACS
What criteria are used to diagnose Heart Failure?
Elevated BNP and at least one additional criterion such as left ventricular hypertrophy or diastolic dysfunction.
p.29
Management Strategies for Heart Failure
What did the TOPCAT Trial find regarding Spironolactone?
No benefit in the HFpEF population.
p.15
Complications Associated with ACS
What is Dressler’s syndrome?
Pericarditis post myocardial infarction.
p.13
Complications Associated with ACS
What is a potential complication of an inferior MI?
Heart block or bradyarrhythmias.
p.8
Diagnosis and Investigations for ACS
Why is a decrease in platelets significant in acute coronary syndrome?
It indicates contraindications to thrombolysis.
p.26
Management Strategies for ACS
What device is recommended for patients with severely reduced EF (≤30%) in HFrEF?
Implantable cardiac defibrillator.
p.7
ECG Interpretation in ACS
Which condition is characterized by an S-wave in lead I, a Q-wave in lead III, and T-wave inversion in lead III?
The classic S1Q3T3 pattern.
p.18
Pathophysiology and Aetiology
What causes Heart Failure?
A structural or functional cardiac abnormality resulting in reduced cardiac output and/or elevated intra-cardiac pressures.
p.3
Types of Myocardial Infarction
What causes Type 1 Myocardial Infarction (MI)?
An acute event caused by atherosclerotic plaque disruption.
p.18
Types of Myocardial Infarction
How is Heart Failure classified based on Ejection Fraction (EF)?
It is classified into HF Reduced EF (HFrEF), HF mid-range EF (HFmrEF), and Heart Failure Preserved EF (HFpEF).
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Clinical Features and Symptoms of ACS
What are the symptoms of NYHA Class I heart failure?
No limitation in normal physical activity.
p.22
Differential Diagnosis of ACS
What are common symptoms of lower respiratory tract infection that may mimic heart failure?
Shortness of breath (SOB), cough, or myalgia.
p.2
Differential Diagnosis of ACS
What is the typical ECG finding in unstable angina?
May be normal or have non-specific changes.
p.23
Diagnosis and Investigations for ACS
What does the Wells’ Score assess?
The likelihood of pulmonary embolism (PE).
p.3
Epidemiology and Risk Factors for ACS
How does the development of ischaemic heart disease differ between men and women?
It develops on average 7-10 years later in women compared to men.
p.11
Complications Associated with ACS
What are major complications of myocardial infarction (MI)?
Heart failure and valvular heart disease.
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Management Strategies for ACS
When can fibrinolysis/thrombolysis be given in STEMI management?
In patients with symptom onset within 12 hours who cannot receive primary PCI within 120 minutes.
p.8
Diagnosis and Investigations for ACS
What is suggestive of an acute myocardial infarction regarding troponin levels?
A troponin rise or fall of ≥20% with one value above the 99th percentile upper limit of normal.
p.12
Management Strategies for ACS
What anticoagulants should be discussed with cardiology for NSTEMI management?
Unfractionated Heparin (UFH) or Low Molecular Weight Heparin (LMWH).
p.14
Management Strategies for ACS
What type of therapy is recommended for NSTEMI?
Dual antiplatelet therapy.
p.6
Clinical Features and Symptoms of ACS
What does peripheral oedema signify?
Sign of right heart failure and fluid overload.
p.5
Clinical Features and Symptoms of ACS
What should be assessed regarding exercise-related symptoms in ACS?
Exercise-related chest pain and whether it is relieved by rest.
p.6
Clinical Features and Symptoms of ACS
How can you augment the JVP during examination?
By using the hepato-jugular reflex (pressing on the liver).
p.15
Long-term Management and Prevention of ACS
What dietary advice is provided for ACS patients?
Healthy eating for tighter glycaemic control if diabetic and lowering lipids if hypercholesterolemic.
p.23
Epidemiology and Risk Factors for ACS
What can raised WCC indicate in heart failure patients?
Infection that can precipitate heart failure, especially in the elderly.
p.19
Complications Associated with ACS
What types of arrhythmias are associated with heart failure?
Atrial/ventricular tachyarrhythmia and bradyarrhythmias.
p.2
ECG Interpretation in ACS
What are the ECG changes suggestive of acute myocardial ischemia?
New ST Elevation at the J-point in two contiguous leads, ST depression, and T Wave changes.
p.25
Long-term Management and Prevention of ACS
How can enrolling patients in a multi-disciplinary disease management programme (DMP) benefit heart failure patients?
It has been shown to reduce admissions with heart failure and mortality.
p.22
Differential Diagnosis of ACS
What is a key differential diagnosis for heart failure related to acute chest pain?
Acute Myocardial Infarction.
p.25
Long-term Management and Prevention of ACS
What follow-up care is suggested for chronic heart failure patients?
Follow up in an Advanced Nurse Practitioner (ANP) led clinic.
p.11
Long-term Management and Prevention of ACS
What lifestyle changes are recommended for the prevention of Acute Coronary Syndrome?
Increased exercise, reduced salt intake, reduced fatty diet, and smoking cessation.
p.27
Management Strategies for ACS
What is the role of beta-blockers in heart failure management?
They are part of the stepwise treatment approach.
p.11
Management Strategies for ACS
What is the initial management for a patient suspected of having Acute Coronary Syndrome?
Load with dual antiplatelet therapy (Aspirin 300mg + Ticagrelor 180mg or Clopidogrel 600mg if high bleeding risk).
p.27
Management Strategies for ACS
What is the significance of SGLT2 inhibitors in heart failure treatment?
They are included in the stepwise treatment approach.
p.23
Diagnosis and Investigations for ACS
What does elevated BNP indicate?
Acute decompensated heart failure.
p.15
Complications Associated with ACS
What serious arrhythmia can occur if broad complex tachycardias are not treated quickly?
Ventricular fibrillation.
p.14
Epidemiology and Risk Factors for ACS
What key factors should be obtained from the patient's history?
Timeline/onset of symptoms and key risk factors (hypertension, previous events, smoking, diabetes).
p.27
Management Strategies for ACS
What are common contraindications for cardiac transplant?
Malignancy, alcohol/substance abuse, end-stage renal disease, morbid obesity, irreversible pulmonary hypertension.
p.5
Clinical Features and Symptoms of ACS
What is a significant associated symptom of shortness of breath in ACS?
It is usually acute and associated with severe chest pain.
p.27
Management Strategies for ACS
What should never be used together in heart failure treatment?
ACE inhibitors, ARBs, and ARNI’s.
p.3
Types of Myocardial Infarction
How is Type 3 Myocardial Infarction (MI) diagnosed?
On autopsy when patients have sudden cardiac death with symptoms suggestive of myocardial ischemia.
p.2
ECG Interpretation in ACS
What ECG changes are associated with NSTEMI?
ST depression and/or T Wave inversion.
p.8
Diagnosis and Investigations for ACS
What does an ABG assess in patients with acute coronary syndrome?
It assesses for type 1 respiratory failure (pulmonary edema) and lactate levels.
p.19
Clinical Features and Symptoms of ACS
What are the symptoms of NYHA Class IV heart failure?
Symptomatic at rest, severe discomfort with any physical activity.
p.19
Epidemiology and Risk Factors for ACS
What are some causes of heart failure mentioned?
Congenital abnormalities, constrictive pericarditis, renal failure leading to fluid overload, and iatrogenic fluid overload.
p.29
Management Strategies for Heart Failure
What was the significance of the PARADIGM trial?
Entresto was superior at reducing symptoms and mortality in HFrEF compared to ACE inhibitors.
p.8
Diagnosis and Investigations for ACS
What does an elevated CRP indicate in the context of acute coronary syndrome?
It can be elevated in myocarditis or pericarditis.
p.11
Management Strategies for ACS
What is the urgency of revascularization in STEMI diagnosis?
Time is muscle; urgent revascularization (PCI or thrombolysis) is necessary.
p.15
Complications Associated with ACS
What are potential outcomes of cardiac arrest in ACS?
Arrhythmogenic or asystole or pump failure.
p.19
Clinical Features and Symptoms of ACS
What are the symptoms of NYHA Class III heart failure?
Symptomatic at rest, increased discomfort with any physical activity.
