4.2. Acute coronary syndrome / syndrome coronaire aigu Flashcards

1
Q

When to suspect ACS (3)

A

Rest angina, which is usually more than 20 minutes in duration

New onset angina that markedly limits physical activity

Increasing angina that is more frequent, longer in duration, or occurs with less exertion than previous angina

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2
Q

NSTEMI definition (tropo and ECG findings)

A
  1. tropo élevés
  2. ECG:
    - PAS de ST elevation
    could have:
    - ST‐segment depression (STD)
    - T‐wave inversion (TWI),
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3
Q

New onset angina should be considered as

A

UNSTABLE

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4
Q

types of MI (2 main)

A

1 = Spontaneous plaque rupture and thrombus

2 = Ischemic imbalance (demand excess)

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5
Q

Chest pain CAT (stable)

A

1) Labs (4)
- tropo x 2 3h apart
sauf si >12h DRS sx
- FSC (hb)
- E base + étendu (mg,k)
- INR

2) 12 lead ECG

3) CXR

4) Rx:
Everyone:
- ASA 325 PO chew x1
- atorvastatin 80mg PO die

PRN
- metoprolol 25mg PO x 1 prn - yes it does reduce mortality and morbidity if NO CI
- Nitro prn
- morphine prn

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6
Q

Nitro Contre indications (2 + 1 debunked)

A
  • Hemodynamic compromise
  • PDE5i

risk of hypotension

*** hypotension secondary to nitrate use in Right Vent MI is not significantly higher than in other territories (meta analyse)

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7
Q

metoprolol contre indications (5)

A

heart failure
hemodynamic compromise
bradycardia
severe asthma
cocaine

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8
Q

STEMI definition ECG

A

ST segment elevations at J point in 2 contiguous leads >1mm in all leads except V2 and V3

Men <40yo, ≥2.5 mm in V2 and V3

Men >40yo, ≥2 mm in leads V2 and V3

Women ≥ 1.5 mm ST elevation in V2 and V3

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9
Q

NSTEMI definition ECG

A

ST segment depressions or deep T wave inversions without Q waves or no ECG changes

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10
Q

Unstable Angina definition ECG

A

NO ECG changes

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11
Q

When taking chest pain history, ask for contraindications

A

Thrombolysis

Anticoagulation (eg. currently on anticoagulation)

Nitroglycerin (eg. PDE5-i, eg. Viagra)

Metoprolol (eg. cocaine)

Allergy to medications (eg. Aspirin)

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12
Q

score to evaluate risk of bleeding post MI

A

CRUSADE score

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13
Q

NSTEMI vs STEMI pathophysiology - type of blood vessel occlusion

A

STEMI - complete - myocardial infarct

NSTEMI - partial occlusion

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14
Q

Stable vs unstable angine pathophysiology - type of blood vessel occlusion

A

stable angina = luminal narrowing of coronary arteries
aka stable symptoms

unstable angina = plaque rupture and thrombus formation leading to stenosis

aka worsening sx with same activity

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15
Q

STEMI or Equivalent
management (big categories)

A

Reperfusion + Dual antiplatelet + Anticoagulant

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16
Q

Type of reperfusion in STEMI and when (time + ressources)

A
  1. Primary PCI (within 90 mins of medical contact) = if access to cath Lab
  2. If PCI unavailable,
    <120mins of first medical contact,
    <12h symptom onset (unless ongoing symptoms),
    no contraindications (see at bottom of page)

FIBRINOLYSE

17
Q

STEMI antiplatel antiplatelet + Anticoagulant tx

for PCI

A

Dual antiplatelet
- ASA 325 PO chew or by rectum if unable to take PO

  • Ticagrelor 180mg

Anticoagulant
- UFH 50-70 units/kg IV (max 5000 units)

18
Q

STEMI antiplatel antiplatelet + Anticoagulant tx

for Fibrinolysis

A

Dual antiplatelet
- ASA 325 PO chew or by rectum if unable to take PO

  • Clopidogrel 300mg (75mg if age ≥ 75) +

Anticoagulant
- Enoxaparin 30mg IV (adjust for renal and age ≥ 75) or UFH (if possible PCI later)]

19
Q

Reperfusion therapies (2)

A

Primary PCI

or

Fibrinolysis

20
Q

Time contraindications for Reperfusion therapies

A

No reperfusion indicated

> 12h onset of symptoms for Fibrinolysis

> 24h for PCI,

21
Q

Fibrinolysis Dual antiplatelet tx + posologie

A

Dual antiplatelet
- ASA 325 PO chew or by rectum if unable to take PO

  • Clopidogrel 300mg (75mg if age ≥ 75)
22
Q

Primary PCI Dual antiplatelet tx + posologie

A
  • ASA 325 PO chew or by rectum if unable to take PO
  • Ticagrelor 180mg
23
Q

Fibrinolysis anticoagulant posology

A

Anticoagulant
- Enoxaparin 30mg IV (adjust for renal and age ≥ 75)

or UFH (if possible PCI later)]

UFH 50-70 units/kg IV (max 5000 units)

basically UFH works sur toute les sauces

24
Q

PCI anticoagulant posology

A

Anticoagulant
- UFH 50-70 units/kg IV (max 5000 units)

25
Q

If no reperfusion indicated which antiplatelets and anticoags

A

Ticagrelor 180mg + Enoxaparin or UFH

26
Q

NSTEMI or Unstable Angina