ACS Flashcards
what is coronary disease
disease of the arteries that supply the heart with blood. causes myocardial ischaemia
myocardial infarction
cell death in heart due to lack of oxygen
types of ACS
sudden cardiac death (SCD), acute ST elevation myorcdial infarction (STEMI), non-ST elevation myocardial infarction (NSTEMI) and unstable angina (UAP)
how can you differentiate between the types of ACS
measurement of troponin
other diagnostic aids for myocardial infarction
positive cardiac biomarkers (troponin), symptoms of ischaemia, evidence of coronary problem on coronary angiogram or autopsy, evidence of new cardiac damage on another test
sudden cardiac death (SCD),
death due to a cardiovascular cause that occurs within one hour of the onset of symptoms. A sudden cardiac arrest occurs when the heart stops beating or is not beating sufficiently to maintain perfusion and life.
acute ST elevation myorcdial infarction (STEMI)
if ST elevation this is signified. full blown, results in permanent damage if not unblocked, needs fast intervention, in Cath lab with balloons and stents or pharmacologically with strong blood thinner (thrombolysis) Cath lab first if can get to it in 2 hours max
should patients with non-ST elevation myocardial infarction (NSTEMI) have a coronary angiogram too
evidence that patients with NSTEMI with high risk features benefit from an early invasive strategy, most patients will get an angiogram unless it seems likely to be a type II MI or if the risks of the procedure seem too high, ideally do an angiogram within 48 hours
characteristic ECG changes for myocardial infarction
ST elevation if complete occlusion, partial would be ST depression and T wave inversion but may be normal. Later on it could have Q waves for complete or no Q waves for partial. opposite changes on opposite leads for posterior MI
Importance of rapid intervention
results in permanent damage if not unblocked
Acute treatment for ACS
admit to hospital, ECG (repeat a few times), attach to cardiac monitor, gain IV access, give O2 if levels are low, blood tests (check troponin and general bloods), treat with GTN or opiates or aspirin to avoid clotting and anti platelet drugs
type 1 MI
plaque rupture with thrombus
risk factors
male, old, diabetes, high bp, high cholesterol, smoker, family history
Common complications of ACS
arrhythmic (VF) or mechanical (myocardial rupture, acute ventricular septal defect, mitral valve dysfunction due to papillary muscle rupture) both can lead to death
Glycerol trinitrate
opens up coronary arteries, can give sublingual or as intravenous infusion, won’t help if artery is completely blocked
