Acute Coronary Syndrome Flashcards
What is Acute Coronary Syndrome ?
A condition that encompasses a range of conditions to include NSTEMI, STEMI and ANGINA.
What is NSTEMI ?
NSTEMI is partial blockage of the coronary artery caused by the rupture of ATHEROMA.
What is Atherosclerosis ?
Atherosclerosis is the build up of Atheroma, a Atheroma is a progressive process of the build up of cholesterol, it causes the artery to harden and narrow the lumen. The build up of Atheroma occludes the artery causing a lack of oxygen rich blood to reach the heart.
The Coronary arteries arise from where ?
The Aorta Root
The left main artery divides into what ?
The left anterior descending artery and the circumflex coronary artery.
What is the role of the Coronary Arteries ?
To supply oxygen rich blood to the heart, the arteries run over the hearts surface.
What is cholesterol ?
Cholesterol is a fatty substance mainly made in the liver and ingested saturated fats.
What is LDL cholesterol ?
LDL Low density lipoprotein otherwise known as bad cholesterol carries cholesterol from the liver to the cells that need it. Any excess cholesterol may attach itself to the epithelial lining of the artery otherwise know as atheroma.
What is HDL cholesterol ?
HDL High density lipoprotein otherwise known as good cholesterol carries cholesterol away from the cells back to the liver where it is broken down or excreted as a waste product.
Who is at risk of developing Coronary Artery Disease ?
Patients who have modifiable risk factors Hypertension , Smoking , excessive alcohol intake , overweight patients, Non modifiable risk factors increasing age , family history of heart disease, Ethnicity, gender.
What is Angina ?
Angina is severe pain in the chest brought on by physical exertion. The pain is caused by the reduced blood flow to the heart. Pain will stop at rest.
What is unstable Angina ?
Unstable Angina is more unpredictable as it doesn’t have have a trigger and came happen at any time. Pain will continue despite resting.
What is a STEMI ?
A STEMI is an ST Elevation Myocardial Infarction. This is caused when there is a full blockage within the artery caused by the rupture of the atheroma plaque. this prevents any blood supply reaching the heart causing cardio myocytes to die . The heart muscle becomes permanently damaged,
What is the pericardium?
A serous membrane that is attached to the outer most layer of the heart. The thick white membrane of fibrous tissues anchors the heart to the major blood vessels including the aorta to the sternum and diaphragm.
What is the myocardium?
The muscular wall of the heart it allows the blood to pump blood into the aorta and relax again as the heart fills
What is the endocardium?
The inner most layer of the heart it lines the chambers and valves of the heart and ensures a smooth flow of blood through the heart.
What Changes will you see on a 12 lead ECG in a STEMI ?
Elevation in the ST Segment
What Changes will you see in a NON STEMI in a 12 lead ECG ?
May see ST depression or an inverted T Wave
Will you see increased Troponin levels in a NON STEMI ?
Yes !!
Why does a patient get crushing chest pain ?
Due to Myocardial Ischemia and coronary occlusion
Imbalance between oxygen supply and demand
Blood trying to push through an obstruction ..Lack of OB causes pain
Triggers inflammatory response
Change from anaerobic resp to anaerobic resp causes lactic acid build up
Causes swelling ,pressure and oedema presses on nerve endings
Why will a patient present being sweaty and clammy ?
Arterial occlusion has triggered the SNS..Adrenaline and Noradrenaline from the adrenal medulla.
Adrenaline and noradrenaline effects on alpha and beta receptors causes
Tachycardia
Peripheral vasoconstriction
As compensatory mechanism fail increased ischemia to the heart will increase
Why will a patient vomit ?
Stimulation of the medullary vomiting centre
Hypoxia will exert pressure on the vomiting centre
May be mild or severe
Why will a patient be SOB?
Reduced blood flow results in o2 reserves being used rapidly
As left ventricular deteriorates pulmonary oedema may develop
Change form aerobic to anaerobic metabolism cause leads to loss of myocardium contraction.
What is a PPCI ?
Primary Percutaneous Coronary Intervention
Balloon inserted into coronary artery and inflated to compress the atheroma
Stent inserted to hold back atheroma and prevent re-occlusion
