Acute Coronary Syndrome Flashcards
Definition of ACS
Unstable angina + evolving MI
3 categories of ACS?
ST elevation
LBBB
Non-ST elevation
ACS pathophysiology?
Type 1: Atherosclerotic plaque rupture, thrombosis and inflammation
Type 2: MI secondary to ischaemia due to increased oxygen demand or reduced supply due to coronary spasm/embolism/arrhythmia/anemia/hypotension etc.
Levine’s sign?
Patient describing pain by putting clenched fist on chest
Symptoms of ACS?
Acute central/left chest pain lasting > 20min, radiating to left arm or jaw Nausea Sweating Dyspnoea Palpitation
Signs of ACS?
Anxiety Pallor sweating Pulse or BP up/down 4th heart sound Signs of LVF PSM (due to MR)
ACS Differential
Angina Peri/myo/endocarditis Dissection PE/pneumothorax/pneumonia Costochondritis GORD, oesophageal reflux Anxiety
What is the STEMI sequence on ECG?
Normal ST elevation and hyperacute T waves Q waves Normalisation of ST segments T wave inversion
What is seen on ECG during a NSTEMI?
ST depression
T wave inversion
Which waves are NOT present in a subendocardial infarct?
Q waves
What are troponins and how are they used to diagnose MI?
Troponins are myofibrillar proteins linking actin and myosin.
They are released 3-12 hours post-MI, peak at 24h and return to baseline in 5-14 days.
Need to monitor troponins for 12h to exclude MI
What is the difference between UA and NSTEMI?
UA and NSTEMI may present with typical symptoms and no ST elevation.
UA has NEGATIVE TROPONINS while NSTEMI associated with POSITIVE TROPONINS.
What is the Killip classification for?
4 classes of heart failure post-MI
What are the steps in STEMI management?
ECG O2 (aim for >94% sats) IV access Brief assessment Antiplatelet (aspirin and clopidogrel 300mg PO) Morphine (5-10mg IV) + metoclopramide GTN 2 puffs Beta-blockers LMWH PCI or thrombolysis
When is PCI indicated?
If <12h onset of symptoms
What is PCI?
Angioplasty & stenting
+ GPIIb/IIIa inhibitor (tirofiban) if high risk
When is thrombolysis contraindicated?
If > 24h after pain onset
AGAINST mnemonic
Aortic dissection, GI bleeding, allergic reaction, iatrogenic (recent surgery), neuro (cerebral neoplasm/recent CVA), severe HTN, trauma
What agents are used for thrombolysis?
rt-PA, streptokinase, tenecteplase
What drug is given for 1month post-MI?
Clopidogrel
Continuing therapy post-MI?
ACE-I Beta-blocker Cardiac rehabilitation DVT prophylaxis until fully mobile Statin (regardless of basal lipids)
Management of UA/NSTEMI?
Same as STEMI (ECG, O2, IV access, assessment, aspirin, clopidogrel, fondaparinux, analgseia, anti-ischaemia.
Then if high-risk consider PCI/thrombolysis , but if low risk (UA) then can discharge if troponin is negative.
Continuing therapy is the same.
