ACS - presentation and management Flashcards
What is ACS
New onset of a collection of symptoms related to a problem with the coronary arteries
What do the CA supply?
Myocardial cells
What does an ACS cause?
Myocardial Ischaemia
What is stable angina caused by?
‘Stable’ Coronary leison
What are stable anginal symptoms relieved by?
Rest
What are acute coronary syndromes caused by?
Unstable coronary leison
How do you diagnose ACS?
Detection of cardiac cell death (troponin) AND:
- Symptoms of ischaemia
- New ECG changes
- Evidence of coronary problem on coronary angiogram or autopsy
- Evidence of new cardiac damage on another test
What is a type 1 MI?
Spontaneous MI associated with ischamia and due to a primary coronary event such as plaque erosion, rupture, fissuring or dissection
What is a type 2 MI?
Due to imbalance in supply and demand of oxygen. Result of Ischaemia but not ischaemia from thrombosis of CA
What is a type 3 MI?
Sudden cardiac death, Including cardiac arrest, with symptoms of ischaemia, accompanied by new ST elevation or LBBB. Verified coronary thrombus by angiography or autopsy but death occurring before blood samples could be obtained or before biomarkers appear in the blood
What is a type 4a MI?
MI associated with PCI. PCI related crease of biomarkers greater than X 99th percentile of the upper reference limit is by convention defined as MI
What is a type 4b MI?
MI associated with verified statement stent thrombosis via angiography or autopsy
What is a type 5 MI?
MI associated with CABG, >5 x99th percentile upper reference limit plus new Q waves or LBB or imaging of new loss
What does LBBB stand for?
Left bundle branch block, - a cardiac conduction abnormality seen on the electrocardiogram (ECG). In this condition, activation of the left ventricle of the heart is delayed, which causes the left ventricle to contract later than the right ventricle
What type of MI would a vasospasm or endothelial dysfunction be?
MI Type 2
What type of MI would a fixed atherosclerosis and supply-demand imbalance by?
MI Type 2
What type of MI would be a plaque rupture with thrombus be?
MI Type 1
What type of MI would be a supply-demand imbalance alone?
MI Type 2
Describe the history of a patient with a STEMI?
- Ischaemic sounding heart pain
- May radiate to neck/arm
- OFten deny it is a ‘pain’, more of a ‘discomfort, weight or tightening’
- May be associated with nausea, sweating and breathlessness
What does the initial ECG of a person with a complete coronary occlusion show?
ST elevation?
What does the ECG at 3 days show after a complete coronary occlusion?
Q waves
what does the initial ECG of a partial coronary occlusion show?
ST depression
T wave inversion
May be normal
What does the mECG of a partial coronary occlusion at 3 days show?
No Q waves
What may show/not be shown on an ECG of a posterior MI
As the posterior wall supplied by the left circumflex artery may not see any ST elevation anywhere, even if LCx is completely blocked
