Acute Coronary Syndrome Flashcards
Pathophysiology of ACS
Result of a thrombus from an atherosclerotic plaque blocking a coronary artery.
What does the right coronary artery supply
Right atrium and ventricle, inferior aspect of LV and posterior septal area
What does the circumflex artery supply
Left atrium and posterior aspect of LV
What does the left anterior descending artery supply
Anterior aspect of LV and Anterior aspect of septum
Three types of ACS
Unstable angina, STEMI and NSTEMI
Symptoms of ACS
Central constricting chest pain
N&V
Sweating or clammy
Impending doom
SOB
Palpitations
Pain radiating to arm or jaw
Which group of patients might experience a ‘silent MI’
Diabetics may not experience the typical chest pain during ACS
ECG changes in STEMI
ST segment elevation and new left bundle branch block
ECG changes in NSTEMI
ST segment depression, deep T wave inversion and pathological Q waves
Anterolateral ECG lead
I, aVL, V3-V6
Anterior ECG lead
V1-V4
Lateral ECG leads
I, aVL, V5-V6
Inferior ECG lead
II, III, aVF
What is a marker of ACS
Serial troponins (baseline and 6-12 hours after onset of symptoms
Alternative causes of raised troponins
Chronic renal failure, sepsis, myocarditis, aortic dissection, pulmonary embolism
Investigations when someone presents with ACS symptoms
Physical exam, ECG, FBC, U&Es, LFTs, Lipid profile, TFTs, HbA1c and fasting glucose
Acute STEMI treatment
Primary PCI within 2 hours of presentation, thrombolysis if PCI not available
Acute NSTEMI treatment (BATMAN)
Beta blockers
Aspirin 300mg stat
Ticagrelor 180mg stat
Morphine titrated
Anticoagulant - Fondaparinux
Nitrates - GTN
When would you give clopidogrel instead of ticagrelor in acute NSTEMI treatment
If the patient is at a higher bleeding risk
When you would you not give fondaparinux for acute NSTEMI treatment
Unless high bleeding risk
What is the GRACE score?
It assesses the need for PCI in NSTEMI
Complications of MI
Death, rupture of heart septum or papillary muscles, Oedema, arrythmia and aneurysm, dressler’s syndrome
What is Dressler’s syndrome
Post MI, there is a localised immune response which causes pericarditis
Presentation of Dressler’s syndrome
Pleuritic chest pain, low grade fever and pericardial rub, pericardial effusion
