ACS

Question 1

what is the difference between UA, NSTEMI, and STEMI?

Answer 1

UA-ECG changes but myocardial ischaemia not sufficient to cause myocardial damage eg troponin
NSTEMI -ECG changes and positive troponin but not complete occlusion of a coronary artery
STEMI -ST elevation due to complete occlusion of coronary artery and rise in troponin

Question 2

what are the 5 types of MI pathophysiology wise?

Answer 2

1) underlying pathology is plaque rupture/erosion
2) ischaemic myocardial injury in context of mismatch between 02 supply and demand eg sepsis, arrhythmias
3) cardiac death in patients with suspected myocardial ischaemia prior to any cardiac biomarker sampling
4) PCI related
5) CABG related

Question 3

what is the menopause related risk factor for ACS?

Answer 3

premature menopause

Question 4

how does STEMI on ECG progress over time?

Answer 4

https://www.notion.so/ACS-424673267b2f43f7b6224de0fd47a390?pvs=4#cb73aa00af19479482d596b7437096f9

Question 5

bloods for ACS?

Answer 5

FBC -exclude anaemia and infection
U+E
LFTs
fasting lipids -risk stratification
TFTs
troponins T and I
CK -this will be raised in ACS but less specific

Question 6

beyond investigations for ACS?

Answer 6

CXR -initial investigation, presence of HF/pulmonary oedema
echo -assess for regional wall abnormalities
coronary angiography -see intra-coronary thrombus

Question 7

MONA management of ACS?

Answer 7

PO morphine of IV diamorphine eg 2.5-5mg, anti-emetic eg metoclopramide should also be prescribed
oxygen if hypoxic
nitrate -initially SL eg 2 sprays GTN, if ineffeective consider IV or buccal GTN or IV isosorbide dinitrate
a-aspirin -all patients should receive 300mg aspirin crushed or chewed asap