2+ Cardiac Arrest Flashcards
What is a myocardial infarction?
Acute chest pain due to partial or complete occlusion of a coronary artery that results from an unstable plaque in the setting of CAD
How do you classify ACS?
Unstable angina
MI:
- STEMI: complete occlusion, +ve trop, ST elevation/new BBB
- NSTEMI: partial occlusion, +trop, sometimes t-inversion/st depression or normal ECG
What is the pathophysiology of ACS?
Development of an unstable plaque and arterial occlusion
CAD –> plaque –> lipid rich unstable plaque –> thrombus or thromboembolism –> coronary occlusion
NSTEMI: inner wall infarction, smaller infarction, small emboli to small vessel
STEMIs: transmural infarction –> complete occlusion of main coronary artery
What is the clinical presentation of ACS?
- Chest pain: retrosternal, central, crushing, heavy, can radiate to L arm, L shoulder, neck, jaw, back. Typically >20mins
- Associated N, diaphoresis, palpitations
- Orthopnoea, dyspnoea
Atypical presentations: elderly, diabetic, women
- Little to no chest pain
- mostly autonomic symptoms: diaphoresis, N, palpitations, syncope
- More of a retrosternal pressure than pain
- Silent MI in diabetics because of the neuropathy
What Ix do you do for ACS?
ECG:
- STEMI: st elevation, new LBBB, can develop t wave inversion over days
- NSTEMI: normal or st depression, t wave inversion
Trop: will rise within 3 hours, need sequential
CXR: cardiomegaly, fts of HF
ECHO: localise the abnormality of the wall, asses LV function
CAG: urgent in a STEMI
What is the DDx fo ACS?
Stable angina
Pericarditis/myocarditis
Aortic dissection
Takotsubo CM
GORD
Pneumonia
PE
What is the initial management of an ACS?
MONA
Morphine
Oxygen if hypoxaemic
Nitrates
Anti-platelets: all need aspirin
Anti-coagulant: 1 for STEMI (heparin because reversible for surgery) and 2 (heparin and clexane) for NSTEMI
What is the management of STEMI?
Initial MONA + statin
1st line = PCI
- Stenting or ballooning but if that can’t be done
- Should be within 2 hours of MI
2nd line= thrombolysis with altepase
- Will still need PCI later
Long-term: DAPT: aspirin + clopidogrel for 12 mo. Presence of drug eluting stent really determines duration but typically 12mo. Aspirin is life long
What is the management of NSTEMI?
Initial MONA + statin
Just anticoagulation usually but if unstable you refer to have PCI
12 mo DAPT
Lifelong aspirin
What is the non-pharmacological management of ACS?
Lifestyle: quit smoking, physical actiivty, weight loss, diet, reduce alcohol
6week cardiac rehabilitation
What is the long-term pharm management after an ACS?
DAPT 12 mo
Life long aspirin
High dose statin
ACEI
What are the complications after an ACS?
Death
Heart failure
Atrial fibrillation
Ventricular arrhythmias
Acute mitral regurgitation
Free wall rupture –> tamponade
