ACS Flashcards
diagnosis of STEMI
ST elevation >2mm adjacent chest leads
ST elevation >1mm in adjacent limb leads
new LBBB
diagnosis of NSTEMI
2/3 of:
cardiac chest pain
newly abnormal ECG (not ST elevation)
raised troponin
ST elevation - II, III, aVF
inferior
RCA
ST elevation - V1, V2
septal
proximal LAD
ST elevation - V3, V4
anterior
LAD
ST elevation - V5, V6
apex
distal LAD/LCx/RCA
ST elevation - I, aVL
lateral
LCx
ST elevation - V7-V9
posterolateral
RCA/LCx
interpretation of troponin - low
definitely no myocardial cell death
interpretation of troponin - mildly raised
equivocal result, need repeated 6-12hrs
if repeat is raised on repeat = MI
if repeat is stable or falling = MI unlikely
interpretation of troponin - definitely raised
MI confirmed
STEMI Mx
Oxygen loading dose aspirin 300mg loading dose 2nd anti-platelet sublingual GTN IV morphine
PCI if within 2hrs
NSTEMI Mx
oxygen
loading dose aspirin 300mg + fondaparinux
sublingual GTN
IV morphine
Post-MI Mx
aspirin 75mg 2nd anti-platelet beta blocker ACEI high dose statin
ventricular free wall rupture
necrosis of walls can lead to rupture, allowing blood into pericaridal space
leads to rapid tamponade
Dressler’s syndrome
persistent fever and pleuritic chest pain 2-3wks post MI
Mx = high dose aspirin
