ACS and AMI Flashcards
What three acute coronary syndromes can thrombosis in a coronary artery lead to?
- Unstable angina - NSTEMI - STEMI
When will symptoms of ACS show?
- At rest - Stable angina will only present on exertion
What is the SOCRATES history of a person with ACS?
- Retrosternal chest pain - Tight band - Radiation to neck/jaw and down arms - Aggravating with exertion, emotional stress - NOT FULLY RELIEVED WITH GTN
What are the non modifiable risks for coronary artery disease?
- Age - Gender - Creed - Family history - Previous angina - Cardiac events
What are the modifiable risks for coronary artery disease?
- Smoking - Diabetes mellitus - Hyperlipidaemia - Hypertension - Lifestyle (exercise and diet)
How do you make the diagnosis of unstable angina (UAP)?
- Angina on effort - Progressive increasing frequency and severity - Often at rest
How do you make the diagnosis of NSTEMI?
- Patient presents with myocardial ischaemic symptoms at rest - ECG will show unelevated ST segment but troponin levels will be high
What will a patient with UAP or NSTEMI show on examination?
- No specific features to find - Check HR, BP - Listen for murmurs and crackles
What will be seen on an ECG of patients with UAP and NSTEMI?
- ST segment depression - ST transient elevation - T wave inversion
Using an ECG how do you differentiate between NSTEMI and UAP?
- UAP ECG changes usually resolve after pain subsides - NSTEMI doesn’t
NSTEMI and UA ECG with ST segment depression
NSTEMI and UA ECG with T wave reversal
What are the possible symptoms of atypical ACS?
- Breathlessness alone (w/ wo/ signs of heart failure)
- Nausea and vomiting
- Epigastric pain (recent indigestion)
What biomarkers are raised after a NSTEMI and UA?
- Cardiac troponin (cTn)
What other condition can raise cTn?
Atherothrombosis
What immediate treatment is needed for NSTEMI and UA?
- DR ABCDE
- MONA
What does MONA stand for?
- Morphine
- Oxygen
- Nitrglycerine (GTN)
- Aspirin
Along with aspirin, what other antiplatelet measure should be given for ACS?
- Clopidogrel
- Prasurgrel
- Ticagrelor
What antithrombotic therapy is available for ACS?
- Low molecular weight heparin (LMWH)
- Fondaparinux (better than heparin)
What other therapies are recomended following ACS?
- B blockers
- Statins
- ACEI
When would coronary revascularisation be used?
- High risk patients
- Benefits outweigh risks
What causes an ST elevation MI?
- Plaque rupture leading to a more complete or totally complete occlusion of coronary lumen
- Infarction of distal myocardium
