ACS Flashcards
Define ACS
A collection of symptoms which result from acute myocardial ischaemia- STEMI- NSTEMI- Unstable angina
Describe the formation of atheroma
Injury to wall of artery
Lipoproteins are oxidised and then taken up by macrophages which have migrated to the site of injury, which then become foam cells.
Cytokine release leads to the accumulation of fat in the wall, as well as smooth muscle proliferation.
Plaque formation occurs
What happens at the site of hte atheroma in ACS?
Rupture of the plaque occurs which leads to aggregation and adhesion of platelets to the area of damage. This causes a thrombus to form, which decreases the lumen of the coronary artery. With enough vasoconstriction, myocardial ischaemia occurs.
What is your initial management of ACS?
ABCDE IV access ECG Give: - Oxygen - Nitrates (2 sprays sublingually) - Aspirin 300mg - Diamorphine
What are the territories that you can determine for ischaemia on ECG?
V1-V4 = anteroseptal (LAD)
V5-V6 = lateral (Cx)
2, 3, aVf = inferior (RAD)
1, AvL = hig lateral (Cx)
What signs do you see on ECG with STEMIs?
ST elevation (reciprocal depression)New LBBBT wave inversionPathological Q waves
What are the main treatments for STEMI?
Thrombolysis (Gold standard)Percutaneous coronary intervention
What are the indications for thrombolysis and PCI?
1mm in 2+ consecutive limb leads- ST elevation >2mm in 2+ consecutive chest leads- Posterior infarct- New onset LBBB
Give some absolute contraindications for thrombolysis
- Stroke in the past 6 months- CNS neoplasia- Recent trauma or surgery- GI bleed in the last month - Bleeding disorder- Aortic dissection
Give some relative contraindications for thrombolysis
PregnancyWarfarinAdvanced liver diseaseInfective endocarditis
Give some complications for thrombolysis
Bleeding HypotensionIntracranial haemmorhageReperfusion arrhythmiasSystemic embolisation of thrombusAllergic reaction (streptokinase)
Give some complications of MI
VF Pericarditis Dresslers Syndrome Cardiogenic Shock Chronic Heart Failure Arrhythmia Left ventricular aneurysm Left ventricular free wall rupture
Describe Dresslers syndrome
Fever, chest pain, pericarditis and pericardial effusion that can occur 2 weeks to months after an MI. Treat with high dose aspirin.
Why do aneurysms form after an MI?
Weakness of the left ventricular wall after an MI predisposes to aneurysm formation.
Associated with persistent ST elevation
Describe the course of LV free wall rupture
Present with acute heart failure secondary to cardiac tamponade, 1-2 weeks after an MI.
