acute coronary syndrome Flashcards
three types of acute coronary syndrome
unstable angina
ST elevation myocardial infarction
non-ST elevation myocardial infarction
what is ischaemic heart disease
gradual build up of fatty plaques in coronary arteries
-> causes gradual narrowing
-> risk of sudden plaque rupture
presentation of ACS
central left sided chest pain
radiate to jaw or left arm
sweating, nausea and vomiting, dyspnoea
investigations in ACS
ECG
cardiac markers: troponins
ECG changes in lead V1-V4 show a blockage in which coronary artery
left anterior descending (anterior)
ECG changes in leads II, III, aVF show blockage in which coronary artery
right coronary artery (inferior)
ECG changes in leads I, V5-6 show a blockage in which coronary artery
left circumflex (lateral)
first line management of ACS
MONA
morphine (only in severe pain)
oxygen (only if needed)
nitrates (sublingually or IV)
aspirin 300mg
management for patient’s who have had a STEMI
second antiplatelet (prasugrel if patient not on anticoag, clopidogrel if they are)
PCI if possible within 120 minutes
fibrinolysis if over 120 minutes
long term management of ACS
aspirin
second antiplatelet if appropriate (clopidogrel)
beta blocker
ace inhibitor
statin
management of NSTEMI/unstable angina
aspirin 300mg
fondaparinux- if no PCI planned
PCI or conservative depending on risk of mortality
if PCI:
- give unfractionated heparin
when to refer a patient with chest pain to the hospital
current chest pain or chest pain in the last 12 hours with abnormal ECG: emergency admission
chest pain 12-72 hours: refer to hospital the same-day for assessment
chest pain > 72 hours: perform full assessment with ECG and troponin
presentation of left ventricular aneurysm following MI
persistent ST elevation and left ventricular failure
patients need to be anticoagulated
presentation of left ventricular free wall rupture following MI
occurs 1-2 weeks after
acute heart failure secondary to cardiac tamponade (raised JVP, pulsus paradoxus, diminished heart sounds)
urgent pericardiocentesis and thoracotomy needed
presentation of ventricular septal defect following MI
occurs in the first week
acute heart failure associated with pan-systolic murmur
needs an echo to exclude mitral regurg
needs surgery asap
what location of infarction is acute mitral regurg more common with
infero-posterior
presentation of acute mitral regurgitation
acute hypotension and pulmonary oedema
early-to-mid systolic murmur
treated with vasodilator therapy but may require surgery
what is the drug therapy given during PCI
radial access: unfractionated heparin with bailout GPI
femoral access: bivalirudin with bailout GPI
management of patient with a STEMI > 120 minutes from PCI
fibrinolysis
- should be given another antithrombin drug
ECG repeated after 60-90 minutes- if still persistent MI consider PCI
tool used to assess if patients with NSTEMI/unstable angina require coronary angiography (with follow up PCI if necessary)
grace score
intermediate > 3%
scoring system to stratify risk after MI
Killip class
