acute coronary syndrome Flashcards
STEMI definition
“STEMI occurs when a coronary artery or one of the smaller branches that supplies blood to the heart becomes suddenly blocked by a blood clot, causing the heart muscle supplied by the artery to die”
NSTEMI/angina definition
In unstable angina and NSTEMI the blood clot causes a reduced blood flow, but not a total blockage so the heart muscle supplied by the affected artery does not die.
significant history of MI patient
prev admission w chest pain or cardiac issue
cardiac condition + medication
DM
operations on heart
allergies
symptoms of MI
SOB Cyanosis Palpitations clammy sweaty Nausea impending sense of doom chest pain - tight, radiating to jaw or L arm, >15min
signs of MI
dyspnoea pale Raised JVP Hypotensive Tachycardia
if concerned for patients ventilation, what investigation?
ABG
XRAY
blood tests for suspected MI
FBC U+Es Calcium Mg Glucose Troponin VBG
STEMI ECG changes
new ST elevation
new left bundle branch block + chest pain
NSTEMI ECG changes
New ST depression
Deep T wave inversion
unstable angina ECG changes
no specific ECG changes
immediate management of STEMI
analgesia nitrate aspirin ticagrelor LMWH
MONA - Morphine, Oxygen (not always), Nitrate, Aspirin
MI analgesia
titrate morphine 2.5-`10mg slow IV bolus
MI nitrate
GTN if BP >90
500mg sublingual
200-800 microgram spray sublingual
repeat after 5 min - max 3 doses
MI aspirin
300mg oral
MI ticagrelor
180mg oral
MI LMWH
subcut
STEMI referrals
discuss senior member
contact critical care outreach team
refer to cardiologist for PCI, thombolysis
consider referral to ICU
when PCI in STEMI
within 12hrs of onset of pain
if not, consider thrombolysis
what if patient not in hospital wherePCI can be done?
blue light transfer to primary PCI centre
when consider ICU in MI?
failure to respond to medical management
patient requires ventilator support
patient required blood pressure support
deterioration of blood gas following medical management
immediate management of NSTEMI
NATAL analgesia nitrate aspirin ticagrelor LMWH
referrals for NSTEMI
dicuss senior member
contact cirtical care outreach team
refer to cardiologist if pain continues or dynamic ECG changes
consider ICU referrl
further management of MI
consider:
- dual antiplatelet therapy (aspirin and ticagrelor)
- ACEi
- beta blocker
- statin
lifestyle advice
cardiac rehab
