acute coronary syndrome Flashcards
what are acute coronary syndromes
spectrum of clinical syndromes char. by ischemia
2 types of ACS
- unstable angina
- MI
- STEMI
- non-STE MI
def. unstable angina
CLINICAL SYNDROME char. by new or worsening coronary ischemia
def. MI
myocardial necrosis due to cor. art. occlusion
what does a Q wave indicate
Q waves tend to imply more loss of myocardium
** central mech of ACS
plaque rupture
when is plaque rupture more common
soft plaques with thin caps
- areas of positive remodeling
what happens when platelets exposed to collagen
- platelet activations
- thrombus formation
- may have coronary spasm
** what does acute ST elevation mean
occlusive thrombus
2 options for non-ST eleveation
- non STEMI
2. unstable angina
what can help on Hx
chest pain or angina equivalent
- unstable pattern
> 20 mins suggest infarct
4 bad Sx for unstable angina
- new onset
- accelerated angina
- rest angina
- post-MI
use of Phx
not specific for ACS
- more for complications
5 possible ECG signs and what they mean
unstable angina/non-STEMI 1. normal 2. T inversion 3. ST depression STEMI 4. ST elevation 5. new LBBB
what do different leads tell you about locations
v1-v4 - anterior wall - LAD
2,3,aVF - inferior wall - RCA
v5-v6 - lateral wall - circumflex
what are cardiac enzymes (2)
- creatine kinase
- troponin
reasonably specific for MI
elevated within 4-6 hours
what are high sens. troponin assays
- ultra-hjigh sens., but at loss of spec.
- stable CAD 11%
what is relationship with enzymes
unstable angina is a CLIN SYNROME
- can have without enzymes
- may have worse angina due to anemia, CO
3 helpful therapies for Sx
- rest
- O2
- pain control
- nitro
- morphine
*** 5 ways to help survival
- thrombus - heparin
- platelets - ASA/clopidegril
- B-blockers
- CAD - statins, ACEi
- education
use of angiography/revasc
- improve prog.
- treat refractory Sx
what is tool to assess prog
TIMI
7 parts of TIMI **
- age >65
- 3 CAD risks
- known CAD
- ASA use before
- Angina x2
- ST-changes
- high enzymes
what is STEMI
= occlusion
- 90% will be infarcted withing 3 hours
Hx for STEMI
angina>30mins
- dyspnea
- diaphoresis
- N/V
Phx for STEMI
- sweating
- tachy
- S3, S4, murmur of mitral regurg
- finding of heart failure
3 important mimics of MI and why important
- PE
- pericarditits - NO HEPARIN
- aortic dissection - NO HEP
what is seen in ECG
ST elev in 2 leads
- 1mm in limbs
- 2mm in precordial
New LBBB is equivalent to STelevation
complications of MI
- tachyarrhymia
- brady arrhtmia
- LV failure
- rupture
- pericardidits
- RV failure
- stroke
** main goal in STEMI therapy
reperfusion
2 options to reperfuse
- pharma
- TPA - angio
- most reliable
5 aspects for post MI prog, and 2 most important
- age*
- LV funct*
- resdiual coronoary disease
- vent. arrythmia
- comorbid disease
