ACS (MI/angina)

Question 1

ACS: unstable angina

Answer 1

aka crescendo angina

history of worsening usual angina pain (worsening stable angina)

occurs at rest
frequent episodes

ST depression in some leads
troponin negative

+sweating, dyspnoea, nausea, pallor

Question 2

treatment for unstable angina

Answer 2

MONA BC

morphine
oxygen
nitrate- GTN or isorbidemononitrate IV infusion
aspirin 300mg

beta blocker
clopidogrel 300mg

Question 3

troponin I and its significance

Answer 3

troponin I is a cardiac specific regulatory sub unit of the contractile apparatus of striated muscle

if cardiac muscle is injured, troponin is released into the ciruculation.

negative troponin mean that there is no irreversible ischaemic damage.

ST depression however indicates a high risk of a subsequent coronary event and therefore should undergo urgent coronary angiography (CABG or PCI and stent)

Question 4

ACS

Answer 4

‘acute coronary sydnrome’

encompasses a range of clinical presentations arising from an acute reduction in / cessation of coronary artery blood flow

• new onset angina
• unstable angina
• NSTEMI
• STEMI
• new onset BBB

Question 5

LV aneurysm

Answer 5

persistent ST elevation on ECG

thrombi can form within the aneurysm which can lead to embolic events (limb ischaemia, ischaemic stroke)

most common cause of ventricular aneurysm is MI