Acute Coronary Syndrome Flashcards
Leading symptom in ACS is
is acute chest discomfort described as pain, pressure, tightness, and burning. Chest pain-equivalent symptoms may include dyspnoea, epigastric pain, and pain in the left arm.
Based on the electrocardiogram (ECG), two groups of patients should be differentiated:
Patients with acute chest pain and persistent (>20 min) ST-segment elevation. This condition is termed ST-segment elevation ACS and generally reflects an acute total or subtotal coronary occlusion. Most patients will ultimately develop ST-segment elevation myocardial infarction (STEMI). The mainstay of treatment in these patients is immediate reperfusion by primary percutaneous coronary intervention (PCI) or, if not available in a timely manner, by fibrinolytic therapy.
2
Patients with acute chest discomfort but no persistent ST-segment elevation [non-ST-segment elevation ACS (NSTE-ACS)] exhibit ECG changes that may include transient ST-segment elevation, persistent or transient ST-segment depression, T-wave inversion, flat T waves, or pseudo-normalization of T waves; or the ECG may be normal.
Diagnostic criteria for MI
the detection of an increase and/or decrease of a cardiac biomarker, preferably high-sensitivity cardiac troponin (hs-cTn) T or I, with at least one value above the 99th percentile of the upper reference limit and at least one of the following:
Symptoms of myocardial ischaemia.
2) New ischaemic ECG changes.
3) Development of pathological Q waves on ECG.
4) Imaging evidence of loss of viable myocardium or new regional wall motion abnormality in a pattern consistent with an ischaemic aetiology.
5) Intracoronary thrombus detected on angiography or autopsy.
Types of MI
Type 1 - atherosclerotic plaque rupture, ulceration, fissure, or erosion with resulting intraluminal thrombus in one or more coronary arteries leading to decreased myocardial blood flow and/or distal embolization and subsequent myocardial necrosis. The patient may have underlying severe coronary artery disease (CAD)
What js
Unstable angina is defined as myocardial ischaemia at rest or on minimal exertion in the absence of acute cardiomyocyte injury/necrosis.
