ACS Flashcards
What is ACS?
Unstable angina
NSTEMI
STEMI
How to differentiate between unstable angina and NSTEMI
Unstable angina - minimal troponin elevation
NSTEMI - troponin elevation
How to differentiate between NSTEMI and STEMI?
Both have raised troponin
NSTEMI = ST depression or new T wave inversions
STEMI = ST elevation
What are the symptoms of ACS?
Crushing chest pain, radiating to left arm, neck, jaw
No improvement rest or GTN
Sweating
Risk factors for ACS?
Previous MI IHD DM Hypertension Positive Smoker
How do you diagnose ACS?
Rise and/or fall of troponin with at least one value above the 99th percentile of the upper reference limit, and 1 of:
- Symptoms of ischaemia
- ECG changes indicative of new ischaemia (new ST-T changes or new left bundle branch block (LBBB))
- ECG changes showing development of pathological Q-waves
- Imaging evidence of new loss of viable myocardium or new regional wall motion abnormality
- Identification of an intracoronary thrombus by angiography or autopsy
Inferior STEMI - which leads on ECG and which coronary artery is affected?
II, III, aVF
RCA
Anterior STEMI - which leads on ECG and which coronary artery is affected?
V1-V4
LAD
Lateral STEMI - which leads on ECG and which coronary artery is affected?
I, aVL, V5-6
LCx
Posterior STEMI - which leads on ECG and which coronary artery is affected?
ST depression in leads V1-V4
PDA
How to confirm posterior STEMI?
V4-6 leads moved to the patient’s back, where they are now named V7-9
ST elevation + Q waves in leads V7-9 = posterior STEMI
Immediate ACS management?
MONA
Morphine
Oxygen (if sats <94%)
Nitrates
Aspirin + clopidogrel/ticagrelor
Long-term ACS management?
BASH
Beta blocker
ACE-I
Statin
Heparin (PCI)
NSTEMI management?
Fondaparinux then risk stratify
High risk - angiography
Low risk - medical management
STEMI management?
Symptoms <12hrs = PCI
Symptoms >12hrs = angiography followed by PCI if necessary
If no PCI within 2hrs = thrombolysis
