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Paramedic Revision > Acute Coronary Syndrome > Flashcards

Acute Coronary Syndrome Flashcards

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1
Q

Define acute coronary syndrome

A

a spectrum of conditions that involve myocardial ischaemia, includes various types of angina and myocardial infarction with ST-segment changes

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2
Q

How can myocardial infarctions be categorised?

A

Non-ST elevation myocardial infarction (NSTEMI) and ST elevation myocardial infarction (STEMI)

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3
Q

What is an NSTEMI?

A

Non-ST elevation myocardial infarction - occurs when thrombus partially or transiently obstructs a coronary artery causing ischaemia and necrosis

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4
Q

What is a STEMI?

A

ST elevation myocardial infarction - occurs when a thrombus causes complete obstruction of a coronary artery resulting in ischaemia and necrosis

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5
Q

What is angina?

A

a disease marked by chest pain caused by insufficient oxygenation of the heart. There are three forms of angina: stable, unstable, and prinzmetal/variant

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6
Q

describe stable angina

A

Occurs as a result of plaque build-up and inappropriate vasocontriction. Also known as exertion angina as blood flow is often adequate at rest but insufficient with exertion, causing pain.

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7
Q

describe unstable angina

A

occurs when atherosclerotic plaque and an associated thrombus partially obstructs blood flow. Unstable angina differs from stable angina as there is a greater degree of vascular obstruction at rest, compromising blood flow and causing pain without exertion.

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8
Q

Describe prinzmetal/variant angina

A

occurs as a result of unexplained vasospasm and not atherosclerotic plaque build-up. Prinzmetal angina is not generally triggered by exercise unlike other forms and can occur at any time.

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9
Q

What is a myocardial infarction?

A

a partial or complete obstruction of a coronary blood vessel resulting in significantly reduced blood flow leading to ischaemia and cell death.

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10
Q

what are the two common reperfusion interventions used in the treatment of an MI?

A

thrombolysis and percutaneous coronary intervention (PCI)/ fibrinolysis

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11
Q

what is thrombolysis?

A

the dissolution of a blood clot by infusing throbolytic enzymes (such as plasminogen activator) into the blood

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12
Q

what is percutaneous coronary intervention (PCI)/ fibrinolysis?

A

the enzymatic breakdown of the fibrin in blood clots

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13
Q

what is the best way to avoid or limit reperfusion injury?

A

attempt reperfusion as soon as possible

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14
Q

what is the difference between thrombolysis and fibrinolysis?

A

thrombolysis refers to the breakdown of a thrombus through the action of various agents whereas fibrinolysis refers specifically to the breakdown of fibrin in blood clots

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15
Q

What are the common complications associated with coronary disease?

A

increased risk of heart failure, dysarrhythmias, MI, chest pain, sudden death

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16
Q

List the clinical manifestations of ACS

A
  • increased HR
  • increased RR
  • diaphoresis
  • nausea
  • vomiting
  • chest pain (typically described as crushing, central, radiating to arm or jaw)
  • syncope
  • fatigue
  • epigastric pain
  • back pain (commonly between scapula)
17
Q

what is a silent MI?

A

Essentially a painless MI, common in elderly people who have neuropathic diseases or diabetes who may not feel the expected chest pain

18
Q

How is ACS diagnosed?

A

a presumptuous diagnosis can be made based on information such as symptoms, family history, patient history, ECG changes, and observations. A definitive diagnosis requires imaging (such as an angiogram) to confirm the presence of plaques. MI’s are generally diagnosed using cardiac markers (like troponin) that are released as a result of cell death.

19
Q

what is the pre-hospital management for ACS?

A
  • rapid transport (time is tissue)
  • administration of GTN
    administration of aspirin
  • pain management (typically fentanyl or morphine)
  • managing dysarrhythmias where possible
  • risk elimination once primary needs are managed
20
Q

is oxygen therapy recommended to treat ACS pre-hospitally?

A

Oxygen therapy is only recommended when patients are hypoxic (O2 saturation under about 93)

21
Q

How can arrhythmia be managed pre-hospitally?

A 
narrow complex tachycardias 
- standard or modified Valsalva
- administration of adenosine 
- synchronised cardio version 
- electrocardioversion 
broad complex tachycardia 
- Amiodarone infusion
- synchronised cardioversion 
bradycardia 
- atropine administration 
-  adrenaline infusion 
- transthoracic pacing
22
Q

what is the dosage of GTN used in ACS treatment?

A

300 micrograms every 5 minutes as needed, considering BP and having taken no PDE-5 inhibitors within 48hours (SAAS guidelines)

23
Q

what are some risk factors for the development of ACS or other coronary diseases?

A

hypertension, smoking, high fat diet, high glucose levels, family history, being male, advancing age, hyperlipidaemia, cardiac history

24
Q

what are the benefits of using fentanyl or morphine in the treatment of ACS?

A
  • pain management
  • reduction of anxiety
  • decrease in sympathetic nervous system outflow
  • reduced oxygen consumption
  • can dilate coronary vasculature
25
Q

what are the risks of administering fentanyl or morphine in the treatment of ACS?

A
  • can cause a decrease in blood pressure

- can cause respiratory depression which can impact oxygenation

26
Q

e

A

e

27
Q

What is the HEART Score?

A

a scoring system used when a patient presents with chest pain, it uses risk factors to identify the risk of a patient experiencing adverse outcomes from ACS in short-term period.

28
Q

Why is GTN used in the treatment if ACS?

A

GTN causes a relaxation of vascular smooth muscle causing vasodilation. As a result blood pressure and pre-load decrease, placing less stress on the heart resulting on a reduction of oxygen demand

29
Q

what is the dosage of aspirin used in the treatment of ACS?

A

300mg oral if not already administered

30
Q

What is the mechanism of action of aspirin?

A

aspirin impairs platelet aggregation via inhibition of platelet thromboxane A2 synthesis (therefore impacting the clotting cascade), hence reducing thrombus formation on the surface of a damaged arterial wall

31
Q

what are the categories in the HEART score?

A 
History (of the event)
ECG
Age
Risk factors (e.g. smoking, hypertension, etc.)
Troponin

Paramedic Revision (22 decks)

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