ACS Flashcards
What is the pathological difference between stable and unstable angina?
Unstable angina: Caused by rupture of plaque → death of myocardium
Stable angina: fibrous cap
What are the differentials for CP in the acute setting?
unstable angina; MI (NSTEMI or STEMI); PE; reflux; MSK; aortic dissection
mx of MI?
DAPT: aspirin + clopidogrel/ ticagrelor;
pain relief → paramedics usually give aspirin + morphine NO to nitrates; oxygen only if sats low (MONA is out of date)
F/U with anticoagulant eg heparin/ fondaparinux for 24-72 hrs;
DAPT for a year then aspirin alone for life;
ACE-I and BB;
treat complications eg arrhythmia; cardiac rehab and lifestyle etc.
Angio and stent → immediate for STEMI; NSTEMI within 72 hrs or sooner if needs be
what is the gold standard test for CAD?
ANGIO → gold standard, CT (chronic - CAD), invasive (acute- MI) →
What is stable angina?
CAD plus sx
Mx of stable angina?
Reduce attacks: via nitrates; BB; CCB; nicorandil; ivabradine; ranolazine
If couple plus statins etc not working → stent/ CABG → causes less sx but does not make you live longer eg like a hip replacement doesnt make you live longer but improves QOL
What sx are associated with cardiac caused CP?
Nausea and vomiting Sweating and clamminess Feeling of impending doom Shortness of breath Palpitations Pain radiating to jaw or arms
What is required for the diagnosis of a STEMI?
ST segment elevation in leads consistent with an area of ischaemia
New LBBB also diagnoses a “STEMI”
What may be the ECG features of a NSTEMI?
ST segment depression in a region
Deep T Wave Inversion
Pathological Q Waves (suggesting a deep infarct – a late sign)
What may cause a rise troponins other than ACS?
Chronic renal failure Sepsis Myocarditis Aortic dissection Pulmonary embolism
What should be done if primary PCI cannot be done within 2 hrs for a STEMI?
fibrinolysis eg alteplase or streptokinase
What is a mneumonic to remember acute NSTEMI mx?
BATMAN BB Aspirin 300mg stat Ticagrelor 180mg stat/ clopi 300mg Morphine Anti-coagulant eg LMWH Nitrates for coronary spasm
What is Dressler’s syndrome?
pericarditis 2/3 weeks post MI
