ACS and stable angina Flashcards
ACS is an umbrella term for what, what disease leads to ACS
STEMI and NSTEMI, unstable angina
ischaemic heart disease - narrowing of coronary arteries and possible rupture
ischaemic heart disease risk factors
age, gender, fh
smoking, diabetes, hpt, hypercholoesterolaeima, obesity
Pathophys of ischaemic heart disease
smoking, hpt and hyperglycaemia causes endothelial dysfunction
endothelium becomes pro inflammatory, pro oxidanr, proliferative and decreased nitric oxide
fatty infiltration of sub endothelial space by LDLs
monocytes migrate from blood and differentiate into macrophages
macrophages then phagocytose oxidized LDL, slowly turning into large ‘foam cells’.
smooth muscle proliferation and migration from the tunica media into the intima results in formation of a fibrous capsule covering the fatty plaque.
symptoms of ACS
central/left sided chest pain
radiates to jaw or left arm
heavy or constricting
dyspnoea, sweating, nausea and vomiting
investigations
ECG and troponin
ECG changes and coronary territories, arteries
anterior - V1-4 - LAD
inferior - II, III, aVF - right coronary
lateral - I V5-6 left circumflex
treatment for ACS
MONA
morphine
oxygen
nitrates
aspirin
if stemi give extra antiplatelet (clopidogrel, ticagrelor)
- PCI
secondary treatment
aspirin
beta
ace
statin
GRACE score
age
hr, bp
cardiac killip class and renal function (serum creat)
cardiac arrest on presentation
ECg findings
troponin levels
killip class
used to stratify risk post mi
I - no clinical signs
II - lung crackles, s3
III - frank pulmonary oedema
IV - cardiogenic shock
STEMI ecg criteria
2.5mm ST elevation in leads v2-3, 1.5mm in v2-3 women
1m st elevation in other leads
new LBBB
coronary reperfusion guidlines for stemi
if stemi
pci if pt presents within 12hr of symptoms and can be given within 2hrs
fibrinolysis if pci cannot be given within 2hrs, repeat ECG after 60-90 minx and give pci if not resolved
prior to PCI give dual antiplatelet - aspirin and prasugrel (if not on antocoag) or clopidogrel (if on an anticoag)
drug therapy during pci
heparin with bailout GPI if radial access, bivalirudin “” if femoral access
NSTEMI management
antithrombin - fondaparinux if low risk of bleeding and not having angiography immediately
if immediate angigraphy given or creatinine>265 then heparin given
grace score
pci - heparin, prior and further dual antiplatelet
medication for angina pectoris (stable)
aspirin and statin
GTN
beta blocker or calcium channel blocker (verapamil, diltiazem) first line
if used in combination use longer acting calcium blocker (amlodipine)
don’t give b blocker and verapamil (risk of complete heart block)
if b and c not tolerated together consider
long acting nitrate
ivabradine
nicorandil
ranolazine
