ACS Flashcards
What is ACS?
Unstable angina (present at rest) Myocardial infarction
What ist he underlying pathology in ACS?
Athersclerotic plaque rupture
Exposure of blood to thrombogenic materiall
Thrombosis and inflammation
What is myocardial infarction?
Myocardial cell death, releasing troponins
What is ischaemia?
Lack of blood supply
How can you differentiate unstable angina and MI?
MI has troponin rises, unstable angina does not
What indicates STEMI vs NSTEMI?
STEMI -aCS with ST segment elevation or new onset LBBB
NSTEMI - trop positive ACS without ST segment elevation, ECG may show ST depression, T inversion, non-specific changes or be normal
What are risk factors for ACS?
Non-modifable: Age, male, Fox of IHD
Modifiable: smoking, hypertension, hyperlipidaemia, DM, obesity, sedentery lifestyle, cocaine use
How is MI diagnosed?
Increase in cardiac biomarkers (troponin, creatine kinase)
Symptoms of ischaemia, ECG changes of new ischaemia, development of pathological Q waves, new loss of myocardium, regional wall motion abnormalities on imaging
What are symptoms of MI?
Acute central chest pain > 20 minutes
Crushing, tight, radiates to arm, shoulder, jaw, neck
Associated with nausea, sweatiness, dyspnoea, palpitations,
How do silent MIs present?
Syncope, pulmonary oedema, epigastric pain, vomiting, post-operative hypotension or oliguria, delirium, stroke
What are signs of MI?
Distress Anxiety Pallor Sweatiness Tachycardia/bradycardia Hyper/hypotension 4th heart sound Signs of heart failure (raised JVP, 3rd heart sound, gallop rhythm, basal crepitations) Pansystolic murmur Low grade fever
Later: pericardial rub or peripheral oedema
What tests would you do for MI?
Bedside:
ECG
Blood:
FBC, U&E, glucose, lipids, cardiac enzymes - troponin, CK
Imaging: Echocardiogram - regional wall abnormlaities
What are differentials for chest pain?
Stable angina Pericarditis Myocarditis Takotsubo cardiomyopathy Aortic dissection PR Oesophageal reflux/spasm Pneumothorax MSK Pancreatitis
When does MI have worse prognosis?
Elderly
LV failure
ST changes
Describe the ECG changes in MI
STEMI Hours - ST elevation, hyper acute (tall) T waves OR new LBBB Dats - T wave inversion Weeks = ST normal, T wave inversion Months - Pathological Q wave
NSTEMI ST depression T wave inversion Non-specific changes Normal