ACS Flashcards
Three types of ACS
Angina
STEMI
NSTEMI
Diagnosis of ACS
ECG, troponin ( biochemical cardiac markers
What’s STEMI
ST elevation Myocardial Infarction
- ST elevation is a sign of heart attack
Full blown heart attack
Can lead to death
Causes of ACS
Plaque ruptures from within a coronary artery
Causes partial or complete obstruction of that artery
What’s STEMI
Worse form of ACS
Complete obstruction of coronary artery resulting in death of cardiac muscle
Symptoms of Angina
Chest pain( tight, sharp, dull and heavy)
Spreads to left arm m neck, jaw or back)
Triggered by physical exertion or stress
Stop within a few minutes of resting
Nausea , fatigue and SOB
Sweating and diziness
What’s NSTEMI
Partial heart attack
In between stable angina and STEMI
Partial obstruction of coronary artery
Some muscle cells die but can still survive
Difference between stable and unstable Angina
Stable symptoms occur during exercise/ stress and stop on resting
Unstable symptoms occur while resting
Chest pain last longer and more severe pain
Initial Management of ACS
GTN ( bucal or SL)/
IV morphine- ASAP for pain relief
Give Aspirin 300mg ASAP
Oxygen if needed
Insulin- if hyperglycaemic glucose > 11mmol/ ml
Management of STEMI
Aspirin 300mg + clopidogrel/prasugrel/ticagrelor
Then
Heparin(unfractionated for renal impairment)
Or
Antithrombin agent for patients on fibronoylisis
Secondary prevention of CV events following ACS
Cardiac rehabilitation ( lifestyle interventions)
ACEi/ARB
+
BB or Diltiazem or Verapamil
+ Dual Antiplatelet therapy( aspirin and Clopidogrel for 12 months
Or
Dual/Triple therapy with Anticoagulants( aspirin +Clopidogrel + Rivaroxaban)- those with very high troponin
+
Statins( for pts with clinical evidence of CVD)
What are nitrates?
Useful role in angina
Potent coronary vasodilator but principal benefit is a reduction in Venous return which reduces left ventricular work
Three most common forms of GTN
Tablet
Patch
Spray
Side effect of Nitrates
Flushing
Headaches
Postural Hypotension
Arrythmias
Drowsiness
N and V
Cerebral Ischaemia
Duration of action of GTN
Effects only last for 20-30mins
State when long term prophylaxis of ACS is required when spraying GTN
If GTN spray is used more than twice a week
GTN doses for prophylaxis of Angina(Sublingual Tablet)
Take One tablet before activity which is likely to cause Angina
Treatment dose of Angina GTN(SL tablet)
One tablet repeated at 5mins interval if required. If symptoms have not resolved after 2doses, medical attention should be sought
Dose for GTN spray for tx or prophylaxis
Spray 1-2 doses under the tongue
GTN (patches)
One patch changed every 24hrs
Facts about Isorsobide dinitrate
Active sublingual and effective for pts requiring nitrates infrequently
Effective by mouth for prophylaxis(although slow onset of action)
Effect may persist for several hours)
Facts about MR preparation of dinitrate
Duration of action up to 12hrs(give BD)
As the activity of dinitrate may depend on production of active metabolite
Indication of isosorbide mononitrate
Licensed for angina prophylaxis
MR prep OD available
State when IV GTN or isosorbide mononitrate used
Used for severe symptoms of Angina or when SL not effective
