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PHA222 > ACS > Flashcards

ACS Flashcards

1
Q

Define ACS

A

A spectrum of acute myocardial ischaemic states due to unstable plaque rupture and thrombosis in the epicardial coronary artery leading to reduced blood flow.

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2
Q

What are the the 3 major clinical subtypes of ACS?

A
  • Unstable angina
  • Non-ST segment elevation myocardial infraction (NSTEMI)
  • ST- segment elevation myocardial infraction (STEMI)
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3
Q

What is unstable angina?

A

unstable plaque rupture and thrombosis leading to transient occlusion of artery.

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4
Q

What is NSTEMI?

A
  • unstable plaque rupture and thrombosis leading ton partial occlusion of artery,
  • enzymatic evidence of myocardial cell necrosis
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5
Q

What is STEMI?

A
  • unstable plaque rupture and thrombosis leading to complete occlusion of artery and sustained myocardial ischaemi and cell necrosis
  • electrical instability and cardiac arrhythmias increase risk of sudden cardiac death
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6
Q

Describe the major clinical features of ACS.

A
  • Persistent chest pain that radiates to neck/arms/jaw
  • Breathlessness/dizziness due to ischaemia-induced LV dysfunction and cardiac arrhythmias
  • Serial ECG changes: ST-segment depression/elevation, T-wave inversion, pathological P wave development
    Serial cardiac biomarks: serum myoglobin, CK-MB, troponin, myocardial cell necrosis
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7
Q

What are the ECG changes seen in unstable angina and NSTEMI?

A
  • persistent in NSTEMI
  • transient in unstable angina
  • ST-segment depression
  • T-wave inversion
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8
Q

What are the ECG changes seen in STEMI?

A
  • persistent ST-segment elevation

- pathological Q waves development

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9
Q

Describe the diagnosis of ACS

A
  • eliminate ACS secondary to obstructive CAD
  • determine patients’ 6 month risk of adverse CV events
  • clinical assessment: full history, physical examination, cardiac biomarker changes and ECG
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10
Q

What is the non-pharmacological management of ACS?

A
  • mechanical reperfusion - revascularisation with PIC/CABG
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11
Q

Describe the immediate clinical management of STEMI?

A
  • aspirin 300mg PO stat/ clopidogrel if intolerant
  • antiplatelet/anticoagulant
  • supplemental O2 if SaO2 is more than 94%
  • GTN
  • morphine/diamorphine IV for pain
  • BB IV
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12
Q

What is the difference between the anti thrombotic and pro thrombotic system?

A

Anti thrombotic system - inactivities clotting factors and plasminogen fibrinolytic system dissolves blood clots.

Pro thrombotic system - platelet adhesion and aggregation and activation of coagulation cascade forms blood clots.

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13
Q

Give 2 named examples of anti platelet drugs used in ACS management.

A

Aspirin

Clopidogrel

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14
Q

What is the mechanism of action for the anti platelet drug Aspirin?

A

it inhibits the COX enzyme - inhibiting TXA2 synthesis to inhibit platelet activation and aggregation in response to plaque rupture.

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15
Q

What is the mechanism of action for the anti platelet drug Clopidogrel?

A

inhibits ADP-R inhibiting platelet activation and aggregation in response to plaque rupture

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16
Q

Give 2 named examples of anti coagulant drugs used in ACS management.

A

UF heparin

Bivalrudin

17
Q

What is the mechanism of action for the anti coagulant drug UF heparin?

A

indirect thrombin inhibitor - activates anti thrombotic system which inactivates FIIa, FXa, FIXa inhibiting the coagulation cascade.

18
Q

What is the mechanism of action for the anti coagulant drug Bivalrudin?

A

Direct thrombin inactivator - inactivates FIIa

19
Q

Give named examples of the 2 classes of thrombolytic drugs and describe their mechanism of action for thrombolytic therapy used in ACS management.

A

Activation of plasminogen fibrinolytic system to dissolve blood clot in infarct-related coronary artery and restore blood flow.

SK - indirectly-acting plasminogen activator
T-PAs - directly acting plasminogen activators - alteplase, reteplase, tenecteplase

Clot selective and fibrin-enhanced conversion of plasminogen to plasmin

20
Q

What are the adverse effects of thrombolytic drugs?

A

haemorrhage
hypotension
allergic reaction
reperfusion induced arrhythmias

21
Q

Describe the pathway summary for unstable angina and NSTEMI

A
  • 300mg aspirin
  • anti thrombin therapy
  • assess LV function
22
Q

Describe the pathway summary for STEMI

A
  • 1st line - PCI within 120 mins of diagnosis
  • Aspirin AND clopidogrel
  • Assess LV function

PHA222 (13 decks)

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