acute coronary artery syndrome

Question 1

what is ACS?

Answer 1

a syndrome that covers a Heart Attack (MI) and Unstable Angina

These both occur due to Myocardial Ischaemia (sudden reduction of blood flowing to a specific part of the heart) - plaque rupture, thrombosis, and inflammation.

Question 2

what are the 2 types of ACS?

Answer 2

ACS with ST Elevation (Complete Coronary Occlusion - Severe MI)

ACS without ST Elevation (Partial Coronary Occlusion - Minor MI)

Question 3

what are 5 modifiable and 3 non modifiable factors?

Answer 3

Modifiable = Smoking, Hypertension, Diabetes, Obesity, Hyperlipidaemia.

Non-modifiable = Age, Gender, Family History

Question 4

what are 6 differential diagnoses?

Answer 4

Angina

Pericarditis

Myocarditis

Aortic Dissection

Pulmonary Embolism

GORD.

Question 5

what are 6 sypmtoms of ACS?

Answer 5

Acute Central Chest Pain (lasting >20 min)

Palpitations

Breathlessness

Pain in one or both arms, the jaw, neck, back, or stomach

Sweating

Nausea

Dizziness

(In the elderly, or diabetics, or females they may have ACS without chest pain)

Question 6

what are 7 signs of ACS?

Answer 6

Pallor (unhealthy pale appearance)

Raised or Reduced Pulse Rate

Raised or Reduced Blood Pressure

Anxiety

Signs of Heart Failure = Basal Crackles, Raised JVP, Peripheral Oedema (poor prognostic factors)

4th Heart Sound

Pansystolic Murmur

Question 7

what are 4 investigations used to diagnose ACS?

Answer 7

CXR

ECG

Bloods - FBC, U&E, Glucose, Lipids

Cardiac Enzymes - Troponin levels (T and I), Creatinine Kinase (CK-MM, CK-BB, CK-MB), Myoglobin.

Question 8

what is the immediate treatment of ACS?

MONA

Answer 8

Morphine
Oxygen
Nitroglycerine (GTN - spray or tablet)
Aspirin (300mg Orally).