24 Questions
What should a patient with a heart problem do in case of an emergency?
Call the Centre 15 for hospitalization
What is the primary indication for ambulatory troponin dosing in a patient?
An asymptomatic patient with chest pain over 72 hours ago
What is the goal of a reperfusion strategy in patients with a heart attack?
To systematically treat patients within 12 hours of a heart attack
What is the recommended dosage of aspirin in case of a heart emergency?
150 to 325 mg
What should be done for a diabetic patient with an isolated Q wave?
Urgently refer the patient to a cardiologist
What is the primary goal of ECG in a patient with chest pain?
To diagnose a heart attack
What Electrocardiogram (ECG) sign appears after 24 hours?
Q wave
What happens to the ST segment after 48 hours?
It returns to the isoelectric line
What is characterized by the persistence of thoracic pain despite the cessation of the triggering factor?
Syndrome coronarien aigu
Which of the following territories is associated with derivations V1, V2, and V3?
Anterior
What is a sign that is strongly in favor of the diagnosis of unstable angina?
ST segment elevation during crisis only
What is the term for anginal pain that is newly appeared, increasing in intensity or frequency, or occurring at rest?
Angor instable
What is the characteristic of infarctus du myocarde?
Elevation of biomarkers (troponine or CK-MB) associated with a clinical picture
What is a sign that is strongly against the diagnosis of unstable angina?
Absence of ST segment elevation
What is the significance of T wave inversion?
It is a sign of ischemia
Why is an ECG recommended in emergency for patients presenting with signs of SCA?
To establish a baseline for future comparisons
What is the significance of a normal ECG in patients presenting with signs of SCA?
It does not exclude the diagnosis of SCA
Which of the following territories is associated with derivations V7, V8, and V9?
Diaphragmatic
What are the signs of SCA in diabetic patients?
Atypical pain or dyspnea
What is the significance of Q wave presence?
It is a sign of necrosis
What is the characteristic of the ECG in the early stages of ischemia?
Normal ECG or positive asymmetric T waves in the ischemic territory
What is the significance of ST segment elevation?
It is a sign of unstable angina
Can a normal ECG rule out unstable angina or infarction?
No, it cannot rule out either
What is the term for the stage of ischemia where the sus-décalage of the ST appears?
Syndrome of menace
Study Notes
Acute Coronary Syndrome (SCA)
- The syndrome coronarienne aigu (SCA) is characterized by persistent thoracic pain despite the cessation of the triggering factor (e.g., sports, cold, stress) and the administration of nitrate derivatives.
Classification of Coronary Disease
- The disease encompasses three entities:
- Stable angina
- Acute coronary syndrome without ST-segment elevation (unstable angina and non-ST-elevation myocardial infarction)
- Acute coronary syndrome with ST-segment elevation (ST-elevation myocardial infarction)
Unstable Angina
- Angina is considered unstable if it is new (less than 8 weeks), increasing in frequency and severity with exercise, or occurs at rest.
- There is no elevation of biomarkers (troponin or CK-MB).
Myocardial Infarction
- Myocardial infarction is characterized by elevated biomarkers (troponin or CK-MB) associated with a suggestive clinical picture and/or ECG signs (ST-segment modification, new BBB, or Q wave).
ECG Diagnosis
- An ECG is recommended as an emergency procedure for patients presenting with clinical signs of SCA.
- An ECG normal does not exclude SCA.
Clinical Signs
- Typical symptoms of SCA include:
- Retrosternal thoracic pain, often radiating to the neck, jaw, and/or arms
- Non-resolutive after ceasing effort/stress and taking nitrate derivatives
- Sweating and pallor, and possibly agitation
- Note: Clinical manifestations can be absent, especially in diabetic patients, where atypical pain or dyspnea may suggest the diagnosis.
ECG Signs
- The ECG signs follow the chronology of ischemia:
- Initially, the ECG is normal or presents broad, positive, asymmetrical T-waves in the ischemic territory.
- After 2 hours, the ST-segment elevation appears, which translates to the syndrome of threat.
- After 24 hours, the Q wave appears, indicating necrosis.
- After 48 hours, the ST segment returns to the isoelectric line.
- After 72 hours, the T waves invert, which can persist for months or even a lifetime.
Territories of Infarction
- Infarction can occur in various territories, including:
- Anterior
- Inferior
- Right
- Posterior (basal)
- Diaphragmatic (inferoposterior)
- Septal
- Lateral
- Apical
ECG Patterns
- ECG patterns can be characteristic of ischemia, including:
- ST-segment elevation
- Broad, positive, asymmetrical T-waves
- Q waves
- Negative T waves
This quiz covers the concept of acute coronary syndrome, its characteristics, and types. Learn about the differences between stable angina, acute coronary syndrome with and without ST segment elevation.
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