acute coronary syndrome Flashcards
what is a myocardial infarction ?
complete cessation of coronary perfusion
what are the causes of myocardial infarction ?
- atherosclerosis
- ruptured athermatous plaque with superimposed thrombus
- aortic stenosis
- aortic dissection
what are the risk factors of MI ?
non modifiable risk factors: age sex family history modifiable: hypertension dyslipidemia smoking DM obesity
what is the clinical presentation ?
chest pain anxiety sympathetic stimulation vagal stimulation hypotension symptoms of complications
what are the pathological types of myocardial infarctions ?
transmural
sub-endocardial
what is the universal classification of MI?
MI type 1
MI type 2
what is the pathology in type 1 MI ?
plaque rupture with thrombus
what is the pathology in type 2 MI ?
- vasospasm or endothelial dysfunction
- fixed atherosclerosis and supply-demand imbalance
- supply-demand imbalance alone
- sepsis
- hypo perfusion
if there is an anterior wall infarction where is the occlusion ?
anterior descending branch
if there is a lateral wall infarction where is the occlusion ?
occlusion in left circumflex artery
if there is an inferior wall infarction where is the occlusion ?
occlusion in the right coronary artery
what are the investigations for MI ?
ECG
cardiac biomarkers Troponin
coronary angiography
what is the treatment for MI ?
angioplasty
what are the complications of MI ?
left ventricular failure ruptured papillary muscle ruptured interventricular septum extension of infarction mural thrombus arrythmia
what are the complications of cardiac tamponade ?
pulmonary edema
shock
death
what are the late complicatios of MI ?
myocardial aneurysms
pericarditis (dressler’s syndrome)
what is dresslers syndrome ?
post MI pericarditis
what are the different types of ACS ?
unstable angina
NSTEMI
STEMI
what are the troponin test results associated with each type of ACS ?
unstable angina - troponin negative chest pain
NSTEMI - troponin positive chest pain but with no ST elevation , but probably has ST depression or inverted T wave
STEMI - Troponin positive chest pain with ST elevation
what is the difference between stable and unstable angina ?
both are troponin negative chest pains
but stable angina is chest pain on exertion
unstable angina is chest pain at rest
late complication of MI ?
1- myocardial aneurysm and remodelling
2- Dressler syndrome
what is the treatment for pericarditis ?
NSAIDs and colchicine and morphine
what are the rules that must be followed when taking troponin samples ?
taken 3 hours after onset of chest pain
repeated again after 6 hours
what is the management of STEMI ?
1- give oxygen therapy
2- then a loading dose off aspirin 300mg
along with clopidogrel
morphine for pain relief
3- spray GTN or nitrates for symptomatic relief
4- PPCI
initial therapy ( MONA )
what is the management for NSTEMI ?
same initial treatment as STEMI ( MONA )
but give antithrombin treatment - heparin
before performing the angiogram
what drugs should be taken post MI ?
1- Aspirin 75mg OM + second anti-platelet (clopidogrel)
2- Beta blocker (normally bisoprolol)
3- ACE-inhibitor (normally ramipril)
4- High dose statin (e.g. Atorvastatin 80mg ON)
what is the management for dresslerrs syndrome ?
high dose aspirin
