ACUTE CORONARY SYNDROME Flashcards
What is acute coronary syndrome
Symptoms resulting from severe acute myocardial ischemia that may or may not lead to myocardial infarction
Classification of ACS
STEMI
NSTEMI
Unstable angina
Which ACS presents with normal cardiac enzymes
Unstable angina
Risk factors for ACS
Obesity
Dyslipidemia
Hypertension
Diabetes
Smoking
Cause of ACS
Atherosclerosis of the coronary arteries leading to reduce myocardial perfusion
Nature of chest pain in ACS
Sudden onset
Varying degree but often severe and described as tightness, heaviness or constrictive in nature.
Persisting for more than 30 minutes
Not relieved by rest or glyceryl trinitrate
May radiate to the left arm, the neck or jaw
Symptoms of ACS
Chest pain
Nausea
Vomiting
Shortness of breath
Fatigue
Loss of consciousness
Signs of ACS
Restlessness and apprehension
Diaphoresis
Peripheral or central cyanosis
Confusion in the elderly
This may be the only presention of ACS in diabetics and the elderly
Shortness or breath or fatigue
Nature of pulse in ACS
thready, fast, irregular, slow or normal
Nature of BP in ACS
Blood pressure may be high, low or unrecordable
Bilateral crepitations in a patient with ACS suggests
Left ventricular failure
Presence of a third or fourth heart sound in a patient with ACS suggests
Heart failure
Which cardia enzymes are investigated in ACS
CK-MB
Troponins I and T
Investigations in ACS
12-Lead ECG
Echocardiography
Chest X-ray
Cardiac enzymes:
Coronary angiography
Lipid profile
FBC
ESR, CRP
BUE/Cr
RBS
Serum uric acid
Myoglobin
Treatment objectives on ACS
To relieve distress and pain
To limit infarct size
To prevent and treat complications
To reverse cardiac remodelling
To prevent re-infarction
To identify and manage modifiable risk factors
To improve quality of life
Non-pharmacological management of ACS
Reassurance
Encourage bed rest in first 48 hours
Weight reduction
Cessation of smoking
Initial treatment of ACS patients on admission
Oxygen, intranasal, by face mask or nasal cannula
And
Aspirin, oral (chewable), 300 mg stat.
And
Clopidogrel, oral, 300 mg stat.
And
Glyceryl trinitrate, sublingual, 500 microgram stat.
And
Morphine, IV, 5-10 mg stat.
And
Metoclopramide, IV, 10 mg stat.
Role of metoclopramide in ACS management
To prevent vomiting induced by
morphine
Maintenance treatment following immedately after initial treatment
Aspirin, oral, 75-300 mg daily indefinitely
And
Clopidogrel, oral, 75 mg daily
Patients who receive revascularisation
therapy will require clopidogrel treatment for up to……………
12 months
Anticoagulation treatment in ACS
Enoxaparin, SC, 1 mg/kg (100 units/kg) 12 hourly
Dose of beta blockers used in ACS
Atenolol, oral, 25-100 mg daily
Or
Bisoprolol, oral, 5-20 mg daily
Or
Metoprolol, oral, 50-100 mg 8-12 hourly
Role of beta blockers in ACS
Prevention of cardiac arrhythmias
Reduction of myocardial
workload
Role of ACEi or ARB in ACS
To prevent cardiac remodelling and improve survival
Dose of ACEi/ARBs in ACS
Lisinopril, oral, 2.5-20 mg daily
Or
Losartan, oral, 25-50 mg daily
Or
Candesartan, oral, 4-16 mg daily
Dose of statins in ACS
Atorvastatin, oral, 20-40 mg daily
Or
Rosuvastatin, oral, 10-20 mg daily
Or
Simvastatin, oral, 40-80 mg daily.
ACEIs and ARBs should be avoided when systolic BP is below
100mmHg
Role of statins in ACS
To stabilise the clot and reduce blood cholesterol levels
Statin therapy in ACS is indicated based on the lipid profile
False
Role of ISDN in ACS
To improve coronary dilatation and reduce myocardial workload
Dose of ISDN in ACS
Isosorbide dinitrate, oral, 10 mg 8-12 hourly
Complications of ACS
Pulmonary oedema
Cardiogenic shock
Cardiac arrhythmias
