ACS Flashcards
Indicators of cardiac problems
-chest pain
-dyspnoea
-nausea
-dizziness
-syncope= fainting, LOC
-palpitations
-oedema
-pale, clammy
Signs + symptoms of cardiac problems (SOCRATES)
Site- chest pain, some epigastric abdominal pain, often retrosternal
Onset- typically gradually worsens
Character- typically dull ache, weight on chest, tightness
Radiates- arm, neck, jaw
Associated symptoms- pallor, diaphoresis (sweating), nausea + vomiting, anxiety, SOB, fatigue
Time interval- constant
Aggravating/ relieving factors- can worsen with palpitation of chest wall but not typically
Severity- mild to severe
Silent MI
-MI without chest pain
-seen in older people with dementia, diabetes, chronic renal disease, women
Cardiovascular physical assessment
IPA, ECG, vitals
Inspect
- face- pain, pallor, sweaty
-hands- temp. , pale
-chest- scars, wounds, bruising, ICD (implantable cardioverter defib)
-legs- swelling, erythema (redness)
Palpate
-chest- is it tender
-pulses- rate, rhythm, strength
Auscultate
-stethoscope for heart sounds
Places to hear heart sound
-2nd right intercostal space- aortic valve
-left sternum 4th intercostal space- tricuspid valve
-5th left intercostal space- bicuspid valve
-2nd left inter costal space- pulmonic area
Just listen inn one place
-erbs point- left of sternum, 3rd intercostal space
ACS
-what causes it, conditions it encompasses
-acute coronary syndromes
-due to sudden reduction of blood flow to heart
-usually caused by blood clot within coronary artery
Range of conditions
1. ST segment elevation MI (STEMI)
2.no ST segment elevation MI (NSTEMI)
3. unstable angina
Differences between conditions of ACS
-STEMI- ST elevation on ECG
-NSTEMI- other ECG changes (ischemia, T wave changes), raised troponin levels
-unstable angina- troponin levels not raised but presents with ACS
ST elevation on ECG
-line between s and t waves is raised slightly so doesn’t look like a normal ECG
Athersclerosis-
Thrombus development-
-build up of fatty deposits/ plaque (atheroma)
-blood cells and platelets accumulate creating thrombus/ blood clot
Ischaemia-
Infarction-
-reduction of blood supply causing shortage of oxygen
-tissue death (necrosis) due to lack of blood supply
Risk factors for ACS
Modifiable and non
SHHODD + AGGED
Modifiable
-smoking
-obesity
-diet, exercise
-hyperlipidaemia (excess of lipids)
-hypertension
-diabetes
Non modifiable
-age
-gender
-ethnicity
-genetics
-diabetes
Management of ACS
Analgesia- IV into left arm, morphine administered slowly, paracetamol, reduces pain and reduces cardiac strain
Oxygen- only is below 94% or 88% for COPD
Aspirin- anti platelet to reduce clot, 300mg tablet chewed even if patient takes daily
Anti emetic- anti sickness, typically ondansetron
Nitrates- GTN spray under tongue for vasodilation of blocked vessel
ACS pathways and when to complete which pathway
If meet criteria for STEMI follow pathway 1
1. ST elevation- pre alert, go straight into surgery in PPCI centre(primary percutaneous coronary intervention)
Chest pain but non diagnostic ECG follow pathway 2
2. No ST elevation- go to A&E with cardiac unit, have troponin test
3. chest pain in last 12 hours- refer
Stable angina
-due to narrowing of arteries
-people will have GTN spray at home to manage pain
-angina patients have higher risk of ACS so if first symptoms= ACS manage as ACS
Typical presentation of stable angina and what to do
-pain on exertion
rapidly resolves in under 15 mins with rest or GTN
-if no new symptoms and normal ECG can leave at home with GP follow up
