Acute Coronary Artery Syndromes Flashcards
What are the acute coronary syndromes?
STEMI, NSTEMI and unstable angina
What three factors can a diagnosis of MI be made from?
appropriate clinical history, a 12 lead ECG and biochemical markers like troponin and CK-MB.
What pathophysiology is common to all of the acute coronary syndromes?
Plaque rupture or erosion causing thrombus formation, platelet aggregation and adhesion, vasoconstriction and distal thromboembolism
What do platelets release which leads to vasoconstriction and reduced blood reaching the myocardium?
Serotonin and Thromboxane A2
What 3 chest symptoms might an ACS patient present with?
New onset chest pain, chest pain at rest or deterioration of angina.
What atypical features might a patient with ACS present with? (3)
Indigestion, pleuritic chest pain, dyspnoea
How will complete occlusion of the coronary vessel look on ECG?
Persistant ST segment elevation and Left bundle branch pattern.
What types of troponin are important in cardiac diagnosis?
Troponin I and troponin T
When should troponin be tested in a patient with chest pain?
As soon as possible and then 12 hours after.
What scoring system is used to statify risk is patients with UA and NSTEMI and what risk factors make it up?
TIMI or GRACE, TIMI is shown
How does aspirin work and what dose should be given to ACS patients?
It blocks Thromboxane A2 which is involved in platelet aggregation. It should be given
Name 3 contraindications to Beta-Blockers
Asthma, AV Block, Pulmonary Odema, bradycardia, sick sinus syndrome,
What clinical signs may be found on CVS examination of a patient with STEMI?
How does ischaemia spread in the myocardium and when it is at its worst what will and ECG show?
The ischaemia spreads from the sunendocardial myocardium deep to the subepicardial myocardium, when the infact becomes transmural Q waves appear on ECG
What is the early medical management for a patient with suspected STEMI? (9) (patient available for PCI)
Brief History/Examination, Morphine, Oxygen (?2-4 L/min), Nitrate, Aspirin, 12-lead ECG, Beta-Blocker, IV acess for medication and biochem + troponin / CK-MB, if PCI then give GP II/II inhibitor (abciximan
