Acute coronary syndrome Flashcards
What are the 3 diagnosis under ACS
- Unstable angina pectoris
- NSTEMI
- STEMI
what are the characteristic with UAP
- Increasing frequency, duration and intensity of chest pain
- No ECG changes
- No elevation of biomarkers
General management of UAP
- Admit to general ward with telemetry
- Repeat ECG and cardiac enzymes
- KIV coronoary angiogram
- Start antiplatelet (aspirin and clopidogrel/ticagrelor)
- Start anticoagulation (SC clexane)
What does NSTEMI with widespread ST depression usually mean
There is subendocardial ischemia, unable to be localised
What is the most important test to differentiate MI from angina
Trop
How long does it take for trop to reflect an MI accurately
3-4 hours
What are the leads that you look at for inferior part of the heart
II, III, avF
What are the leads that you look at for lateral part of the heart
V5, V6. I and avL are high lateral
What are the leads that you look at for anterior part of the heart
V3, V4
Which artery are you looking at when you see II, III, AVF
RCA
Which artery are you looking at when you see V1-V4
LAD
Which artery are you looking at when you see I, AVL
LCA
What is the treatment for STEMI
PCI then DAPT for one year and aspirin life long
what is the treatment for unstable angina
DAPT + LMWH until PCI, then DAPT for 1 year then aspirin
What is the treatment for stable angina
SAPT until PCI then DAPT for 1-6 months and SAPT lifelong
What other medications are essential to start after post-MI other than anticoagulants
Statin, beta-blocker and ACE-I for LVEF <40%. Nitrates only if there are symptoms
In Acute pulmonary edema, what could be the physical examination findings
- Bilateral basal crepitations
- Elevated JVP
What is the management of APO
- Oxygen if hypoxemia (NIV also can be considered)
- Diuretics
- May start short-acting vasodilators eg captopril, hydralazine
