ACS

Question 1

What is the pathophysiology of Atherosclerosis?

Answer 1

1. Damage to endothelial lining of the coronary artery lumen (Diabetes, Hypertension, Smoking)
2. Expression of adhesion molecules
3. LDL’s, Cholesterol and fats bind to adhestion molecules and form on the endothelium (known as fatty streak)
4. Leads to immune response in coronary arteries
5. Macrophages are engorged on Fats, LDLs and cholesterol and become known as foam cells
6. Multiple Foam cells die creating fatty lumps known as Atheroma
7. Smooth muscles cells begin moving into the atheroma and hardening it with calcium
8. The atheroma is then covered wiht a fiborous capsule
9. Leading to Atherosclerosis

Question 2

What is the pathophysiology of ACS

Answer 2

1. Atherosclerotic plaque is damaged exposing the underlying tissue
2. Underlying tissue is thrombogenic
3. Platelet aggregation and formation of platelet plug
4. Thrombin activated
5. Thrombin activate Fibrin
6. Fibrin formed over plaque
7. Clotting cascade causes reduction in Lumen space
8. Leads to reduced blood flow
9. Severe occlusion of coronary artery
10. Ischaemia to cardiac tissue
11. Infarction to cardiac tissue
12. Cardiac Failure
13. Shock
14. Coma
15. Death

Question 3

What is the management for ACS

Answer 3

1. Aspirin 300mg
2. GTN
3. Anti-emetic
4. ECG within 10/60

Question 4

What are the care objectives for ACS?

Answer 4

1. Rapid identification STEMI to facilitate timely reperfusion
2. Provision of antiplatelet Rx (Aspirin)
3. Reduce cardiac workload by treating associated symptoms (Nausea and Pain)

Question 5

What are some differentials for ACS

Answer 5

1. Pericarditis
2. Cardiac Tamponade
3. Pneumonia
4. GORD
5. Aortic Anneurysm
6. PE