ACS Flashcards
What are cardiac biomarkers
- Troponin
- Creatinine Kinase (CK)
How is ACS diagnosed?
- 12-lead ECG: can show ST changes, if preseng
- Cardiac biomarkers
If the ECG shows ST elevation, what do we do
If STEMI if confirmed by ECG, the patient will be taken to the cath lab to be revasculatised
What is done if a pt that complains of chest pain shows an ECG with ST depression or is non-diagnostic?
Other investigations will be needed to determine the course of action
When does TROPONIN show?
After 2 hours of pain onset
What levels of high sensitivity troponin T (nsTnT) do we diagnose NSTEMI?
When hsTnT rise on consecutive samples 2 hours apart!
(Levels greater than 14ug/L are consitered positive)
*the levels should plateau after 48 hours and return to baseline in 10-14 days
When will troponin/hsTnT plateau & return to baseline
Plateau: after 48 hours
Return to baseline: 10-14 days
When does CK-MB serum levels
- elevate?
- peak?
- normalize?
- elevate? 6-8 hours
- peak? 12-24 hours
- normalize? 72 hours
What level of CK-MB is considered normal?
52-175 ug/L
What are other symptoms of ischemia
Chest pain
Diaphoresis
Nausea
Back pain
Jaw pain
What are the N O P Q R S T of ischemic chest pain assessment?
Normal
Onset
Precipitating & Palliative factors
Quality
Region & Radiation
Severity & associated Symptoms
Time
What are the pt’s risk factors of Acute Coronary Syndrome (ACS)
Known CAD or angina
Smoking
Hypertension
Hyperlipidemia
Diabetes mellitus
Previous CABG or PCY
Sedentary lifestyle
Obesity
Family Hx of CAD
Hx of Cocaine use
What happens when the heartdoes not get the right reserve
Increase HR, dilate coronary arteries
When do stable angina start to occur
When plaques grow close to 70%
It is an umbrella term covering unstable angine (UA), non-ST-elevation myocardial infarction (NSTEMI) and ST-elevation myocardial infarction (STEMI)
three syndromes occur when there is an abrupt decrease in the amount of blood flow to the myocardium, leading to ischemia or infarction
unstable angina (UA), non-ST-elevation myocardial infarction (NSTEMI) and ST-elevation myocardial infarction (STEMI)
occurs when there is a complete or nearly complete cessation of blood flow past an occlusion. The distal cardiac tissue is starved of oxygen and necrosis begins in about 10 minutes
STEMI
is due to an incomplete occlusion but still a sudden reduction in the blood flow. Ischemia is occurring but there is still some flow to distal tissue so necrosis is not occurring.
NSTE-ACS
This segment represents the plateau phase of ventricular contraction
ST segment
What represents ventricular repolarization in an ECG
T WAVE
What relates to changes in ST segment height and T wave direction
ischemia, pericarditis, myocarditis, drugs and electrolyte imbalances.
What is the treatment for STEMI
these patients have a complete or nearly complete occlusion of a coronary artery and need to be taken to the cath lab to have the artery opened. The goal is to have them on the cath lab table and have the artery open within 120 minutes of the patient presenting to EMS or the emergency department. If the patient cannot make that time frame (i.e. they live outside the city or in a remote community) the artery can be opened with a thrombolytic, such as TNK.
What is the treatment for NSTE-ACS
These patients are often admitted to hospital and are started on a heparin infusion to prevent the occlusion from expanding and are given anti-ischemic medications while they wait for a cardiac catheterization. Anti-thrombotics include anti-platelet medications such as aspirin or ticagrelor or plavix (clopidogrel). Anti-ischemics include nitroglycerine, beta blockers, calcium channel blockers and morphine. These medications work by decreasing the oxygen needs of the heart or increasing the oxygen delivery (aka blood flow) to the heart.
NSTE-ACS patients are assessed and invasive treatment or medical therapy is determined on an individual basis. Invasive treatment may be stents or if there are several occlusions, the patient will be considered for cardiac surgery.
All patients with ACS should be started on a statin as these are proven to improve survival post- MI.
