ACS and STEMI Flashcards
Acute coronary syndrome
Any condition where blood supplied to heart muscle reduced
What is an NSTEMI
Non ST elevation myocardial infarction
What is a STEMI
ST elevation myocardial infarction
Are STEMIs or NSTEMIs more prevalent
NSTEMIs
2 types of NSTEAC
NSTEMI
unstable angina
How to tell between NSTEMI and unstable angina
troponin positive in NSTEMI
Troponin negative in unstable angina
STEMI characteristics
Persistent Acute chest pain 20min+
ST segment elevation
What usually causes a STEMI
Acute total coronary occlusion
NSTEMI ECG characteristics
No persistent ST elevation
Persistent or transient ST depression
Persistent or transient T wave inversion
Is troponin elevated in STEMI
Yes
When should ECG be taken in suspected ACS
First - before history and examination
What should be done if initial ECG normal in suspected ACS
Repeat/serial ECGs
What are the 3 criteria needed for acute myocardial infarction
Acute myocardial injury - elevated troponin
Rise/fall of cTn values w at least 1 value above 99th percentile
Clinical evidence of acute myocardial ischaemia with at least 1 of - myocardial ischaemia symptoms, new ischaemic ECG changes, pathological Q waves, new loss of viable myocardium or new regional wall motion abnormality in pattern consistent w ischaemic aetiology, coronary thrombus
3 types of ACS
STEMI
NSTEMI
Unstable angina
ACS signs and symptoms
Chest pain >15 mins
Pain in other areas
Nausea
Vomiting
Sweating
Breathlessness
Haemodynamic instability
Abrupt deterioration in stable angina
ACS risk factors
Hypertension
Smoking
High lipid signs
What are xanthelasma and arcus lipids signs of
High lipids
How can acute chest pain be investigated
Blood test
Chest x ray
Resting ECG
Coronary CT
Stress echo
Stress MRI
Myocardial perfusion scan
Coronary angiogram
what does ABCDE stand for in ACS management
Airways and oxygen
Breathing and ventilation
Circulation and shock management
Disability due to neurological deterioration
Exposure and examination
What ACS treatment is needed while waiting for transfer
Anti platelet therapy
Analgesia
Anti platelet therapies
Aspirin
Clopidogrel
Ticagrelor
Prasugrel
Which Analgesics for ACS while waiting for transfer
Glyceryl trinatrate - GTN
Opioids
Limitations of clopidogrel
Slow onset of action
Variable degree platelet inhibition
Variable clinical response
Drug interaction
How often are clopidogrel, prasugrel, and ticagrelor administered
Clopidogrel - once daily
Prasugrel - once daily
Ticagrelor - twice daily
How long does clopigrel, Prasugrel, and Ticagrelor have an effect for
C - 3-10 days
P - 7-10 days
T - 3-5 days
What is the minimum amount of time clopidogrel, Prasugrel, and ticagrelor should be discontinued before surgery
C - 5 days
P - 7 days
T - 3 days
When should oxygen be given to ACS patients
SaO2<90% or PaO2<60mmHg
When are Q waves pathological
> 2mm deep or wide
What is used for rate control in ACS
Short acting beta blockers
What factors are involved in calculating grace score
Age
Heart rate
Systolic blood pressure
Creatinine
Congestive heart failure
Cardiac arrest at admission
ST segment deviation
Elevated cardiac enzymes/markers
When should an immediate coronary angiography be offered
People with unstable angina or NSTEMI where clinical condition is unstable
Wellens syndrome
abnormal electrocardiographic (ECG) pattern, deeply inverted T waves in leads V2 and V3, that are secondary to proximal LAD stenosis
When should an urgent call be made to cardiology for immediate Cather termination consideration
Inability to eliminate chest pain using maximal medical therapy
Wellness syndrome
Dynamic ST Depression
