ACS Flashcards
What is ACS?
Involves STEMI, NSTEMI, Minimal Myocardial Necrosis and Unstable Angina
What are the causes of ACS?
Atherosclerosis with superimposed thrombi
Vasculitic syndrome (Lupus)
Coronary Emboli (endocarditis, artificial valves)
Severe coronary spasm (primary or cocaine induced)
Increased blood viscosity (polycythemia vera, thrombocytosis)
Significantly increased myocardial oxygen (e.g. aortic stenosis)
and
congenital anomalies of the coronary arteries
What are the symptoms of MI?
Pain - described as pressure, burning and it goes to the chest/arms/jaw/back
Sympathetic response - sweats, tachycardia, cool clammy skin
Parasympathetic response - nausea, vomiting and weak
Inflammatory response - mild fever
Other - dyspnea and asymptomatic
What happens to the BP and the HR in anterior MI?
They will increase
What happens to the BP and the HR in inferior MI?
They will decrease
What happens to the right atrial pressure in RV MI?
The Right atrial pressure will increase
What are the signs and symptoms of pericarditis?
Sharp pleuratic pain
Pt prefers to sit
Friction rub
ECG diffuse ST-E
What are the signs and symptoms of aortic dissection?
Instantaneous onset of severe pain
often the aorta on x-ray looks wide
pulse deficits
What are the signs and symptoms of pulmonary embolus?
Pleuratic pain
Dyspnea
Reason for clotting (MVA who had surgery)
What are the signs and symptoms of pneumonia?
Cough
Sputum
Fever
Consolidation changes
What are the signs and symptoms of esophageal spam?
retrosternal burning (Acid) after meals or at night
What happens to the Troponin levels in MI?
They rise 3-4 hours post MI.
Peak at 18hrs -36hrs
decline slowly 10-14 days
When is the Creatinine Kinase (CK) elevated?
After injury to any of the tissues in the heart, brain, kidney or skeletal muscle
CK-MB rises 4-8hrs after MI, peak by 24hrs. Returns to normal in 48-72hrs.
What is the treatment of ACS?
Beta blockers
+/- Calcium Channel Blockers
ACE-I
Nitrates
Analgesia (Diamorphine or morphine)
Supplemental O2
Aspirin
Clopidrogel
Anticoagulants -LMWH or Unfractionated intravenous heparin/ Fondaparinux/Bivalirudin (this is only used in ACS pts undergoing PCI)
Statins
What are acute MI complications?
Recurrent ischaemia/reinfarction
Arrhythmias
Pericarditis from inflammation of the pericardium
Myocardial dysfunction
Stroke (Embolism) form ventricular thrombus
Cardiogenic shock from hypotension -> low coronary perfusion -> increased ischemia
CHF from ventricular thromus or papaillary muscle infarction which leads to mitral regurgitation
Cardiac tamponade from ventricular wall rupture
What is the investigation for poor LVEF?
Echo
What is the treatment for poor LVEF?
ACE-I, BB
What is the investigation for ischaemia?
Exercise tolerance test (ETT)
Max ETT later
What is the management for Ischaemia?
Catheterisation,
ASA (acetylsalicylic acid which is aspirin)
BB
What is the investigation for Arrhythmias?
Monitoring
What is the management for Arrhythmias?
Directed therapy depending on what it is.
