Acute Coronary Syndrome Flashcards
What does Acute Coronary Syndrome encompass?
STEMI
NSTEMI
Unstable angina
What is ACS usually due to?
A thrombus from an atherosclerotic plaque blocking a coronary artery
What is a thrombus usually made up of in an artery?
Platelets
Why are antiplatelet medications used to treat ACS?
Thrombi are made up of mostly platelets
What are examples of anti-platelet medications?
Aspirin
Clopidogrel
Ticagrelor
How does ACS cause problems?
Reduces blood flow to the heart
What is reduced blood flow to the heart known as?
Myocardial ischaemia
What is a STEMI due to?
Complete occlusion of the coronary artery
What type of damage does a STEMI cause?
Irreversible damage
What are other names for a STEMI?
Transmural MI
Q Wave MI
What is seen initially on an ECG of someone with a STEMI?
ST elevation
What is seen on an ECG 3 days after someone has had a STEMI?
Q waves
What does a STEMI cause?
Ongoing myocyte death
What is the criteria for diagnosis of a STEMI?
ST elevation
Or new left bundle branch block
What is the management of a STEMI?
Revascularisation within 12 hours
What are the 2 forms of revascularisation?
Primary Percutaneous Coronary Intervention
Thrombolysis
What is primary percutaneous coronary intervention?
Putting a catheter into the patient’s brachial or femoral artery under xray guidance and injecting contrast to identify the area of blockage
Then put a balloon or device to widen gap
What is thrombolysis?
Injecting a fibrinolytic medication that rapidly dissolves clots.
What is the risk associated with thrombolyisis?
The risk of bleeding
What type of intervention is primary percutaneous coronary intervention?
Diagnostic and theraputic
What is an NSTEMI?
Non-ST elevation MI
What is the criteria for diagnosis of an NSTEMI?
No ST elevation
Raised troponin levels
And/or other ECG changes
What other ECG changes would you get with an NSTEMI?
ST depression
T wave inversion
Pathological Q waves
What is another name for an NSTEMI?
Non-transmural MI
What does non-transmural mean?
MI that does not cause necrosis through the full thickness of the myocardium
What type of damage does an NSTEMI cause?
Ischaemia
Reversible
What is the criteria for diagnosis of Unstable angina?
Troponin levels are normal
The ECG does not show pathological changes
What is a typical history of someone with unstable angina?
Convincing anginal symptoms Rapidly worsening (crescendo history) May now be occurring at rest ECG may be normal NO cell death so troponins will NOT be raised
What will not be raised in unstable angina?
Troponin
What are non-ACS causes of raised troponin?
Chronic renal failure Sepsis Myocarditis Aortic dissection Pulmonary embolism
What investigations would you carry out?
Bloods
ECG
Echocardiogram
Chest x-ray
What would you loo for in the blood?
Troponing T and I
Creatinine Kinase
What does MONA stand for?
o Morphine
o Oxygen if <94%
o Nitrates- GTN
o Aspirin- 300 mg Aspirin ASAP unless allergic – then clopidogrel
Why and when would you do an Echocardiogram?
After the event
To check for functional damage
What is used to ensure that you don’t miss a STEMI with an ECG?
Posterior lead
Why would you do a chest x-ray?
To check for other causes of chest pain
When would you test for troponin?
Baseline
6 hours
12 hours
What is the pneumonic for the treatment of NSTEMI?
BATMAN
What is the pneumonic for the initial management of all ACS?
MONA
What does BATMAN stand for?
B – Beta blockers
A – Aspirin 300mg
T – Ticagrelor 180mg (clopidogrel 300mg alternative)
M – Morphine to control pain
A – Anticoagulant: (LMWH) e.g. enoxaparin 1mg/kg twice daily for 2-8 days
N – Nitrates (e.g. GTN) to relieve coronary artery spasm
What is the pneumonic for complications of an MI?
DREAD
What does DREAD stand for?
D – Death R – Rupture of the heart septum or papillary muscles E – “Edema” (Heart Failure) A – Arrhythmia and Aneurysm D – Dressler’s Syndrome
What is Dressler’s syndrome?
Post-myocardial infarction syndrome.
When does Dressler’s syndrome usually occur?
2-3 weeks post MI
What causes Dressler’s syndrome?
Localised immune response resulting in Pericarditis
How does Dressler’s syndrome present?
Pleuritic chest pain
Low grade fever
Pericardial rub on auscultation
How is Dressler’s syndrome diagnosed?
ECG
Echocardiogram
Raised inflammatory markers
What would you find on an ECG of someone with Dressler’s syndrome?
Global ST elevation
T wave inversion
What would you find on an Echocardiogram of someone with Dressler’s syndrome?
Pericardial effusion
Which inflammatory markers would be raised in Dressler’s syndrome?
ESR
CRP
What is the management of Dressler’s syndrome?
NSAIDs- Aspirin / ibuprofen
Severe cases steroids- Prednisolone
