Acute Coronary Syndrome ☺️ Flashcards
Pathophysiology
Fatty plaque within CA
- narrowing => angina
- plaque rupture => thromboembolus => MI
Risk factors
- unmodifiable
- modifiable
Unmodifiable
- age
- male
- FHx
Modifiable
- smoking
- DM
- HTN
- cholesterol
- obesity
Presentation
Key investigations
Central/L dull pain => jaw, left arm
SOB
Sweating, N+V
Vital signs - normal unless complications found
Key investigations
- ECG - ST depression (ischemia) or ST elevation (infarction)
- TnT
ECG regions for each coronary artery
Anterior - V1-4 LAD
Inferior - II, III, aVF RCA
Lateral - I, V5-6 LCX
How would you manage ACS
- immediately
- secondary
Morphine
Oxygen - if SaO2 < 94%
Nitrates
Aspirin
STEMI - 2nd AP and PCI
NSTEMI - GRACE score to determine risk
-angiography => PCI
Secondary
- ACEi
- dual AP
- Bb
- statin
What is the difference between
- stable angina
- unstable angina
- STEMI
- NSTEMI
- vasospastic
- microvascular
Stable - exertion trigger, resolved with rest/GTN
Unstable - partial block without resolution with rest/GTN, may lead to MI
STEMI - complete block => transmural infarct
NSTEMI - partial block => subendocardial infarct
Vasospastic - at rest, early morning/nights, GTN works
Microvascular - at rest and exertion, menopause link
What are the complications of an MI
- immediately
- 48hrs
- 1wk
Immediate
- CA from VF/VT
- AV block from Inf MI
48hours - pericarditis => Dressler’s syndrome
1st week - VSD, ventricular aneurysm and rupture => cardiogenic shock
Difference between a thrombus and clot
Difference between white/red/septic infarcts
Types of embolism
Thrombus - platelet + fibrin in vasculature
Clot - platelet + fibrin + RBC in tissue
White - arterial occlusion into tissue
Red - venous occlusion out of tissue
Septic - occlusion from septic emboli
Abnormal material impacting vessel
- thromboembolus
- fat
- septic
- air
- tumour/cells
Angina management
-pharmacological
Reduce MI risk
- aspirin + statin
- Bb or CCB (verapamil/diltiazem)
- if both not effective - ivabradine/nicorandil/ranolazine
Attack => GTN
-reduce tolerance by having 10-14hr nitrate free time
Beta blockers
- SE
- CI
SE
- bronchospasm
- cold peripheries
- fatigue
- nightmares
- ED
CI
- uncontrolled HF
- asthma
- verapamil use => bradycardia
Nitrates and nicorandil
- MOI
- SE
- CI to nicorandil
GTN - venous, coronary VD
- hypotension => reflex tachycardia
- headaches, flushing
Nicorandil - GTN + arterial VD
- headaches, flushing
- AVOID IN LVF
CCB
- MOI
- SE
DHPs - peripheral VD
- flushing => headache
- ankle swelling
Diltiazem, verapamil - negative ino/chronotrope
- hypotension, bradycardia
- HF
- ankle swelling
- flushing
