Acute coronary syndrome Flashcards
What does the Left coronary artery become?
The circumflex and left anterior descending artery
Where does the right coronary artery supply?
right atrium
right ventricle
inferior aspect of left ventricle
posterior septal area
Where does the Circumflex artery supply?
left atrium
posterior aspect of left ventricle
Where does the LAD supply?
the anterior aspect of the left ventricle
anterior aspect of the septum
What are the 3 types of ACS?
Unstable angina
ST elevation MI
Non ST elevation MI
When is the diagnosis STEMI?
If there is ST elevation or new left bundle branch block
When is the diagnosis nSTEMI?
If there is a raised troponin and / or other ECG changes (ST depression or T wave inversion or pathological Q waves)
When is the diagnosis unstable angina?
If troponin levels are normal and the ECG does not show pathological changes
What are ACS symptoms?
central, constricting chest pain associated with nausea and vomiting sweating and clamminess feeling of impending doom shortness of breath palpitations pain radiating to jaw or arms
What heart area is the left coronary artery?
anterolateral
What leads is the left coronary artery?
i, aVL, V3-V6
What heart area is the LAD?
anterior
What leads is the LAD?
V1-V4
What heart area is the circumflex artery?
Lateral
What leads is the circumflex artery?
1, aVL, v5=v6
What heart area is the right coronary artery?
inferior
What leads is the right coronary artery?
II, III, aVF
What are some alternative causes of raised troponin?
chronic renal failure sepsis myocarditis aortic dissection pulmonary embolism
What investigations should be carried out for ACS?
same as stable angina Physical exam ECG FBC (anaemia) U&E (ACEi) LFTs (statins) lipid profile TFTs HBA1c
plus
chest xray (chest pain and pulmonary oedema)
Echocardiogram after to assess functional damage
CT coronary angiogram to assess disease
What is the treatment for STEMI?
Primary PCI (within 2 hours) Thrombolysis
What are examples of thrombolytic agents?
streptokinase
alteplase
tenectaplase
Describe PCI
putting a catheter into the patients brachial or femoral artery, feeding that up to the coronary arteries under X-ray guidance and injecting contrast to identify the area of blockage. This can be treated using balloons to widen the gap or devices to remove the blockage. usually a stent is inserted to keep the artery open
What is acute NSTEMI treatment?
BATMAN
Beta blockers
Aspirin 300mg stat dose
Ticagrelor 180mg stat does (clopidogrel 300mg alternative)
Morphine to control pain
Anticoagulant - LMWH - enoxaparin 1mg/kg twice daily for 2-8 days
Nitrates (GTN) to relieve coronary artery spasm
O2 if sats less than 95%
What scoring system is used to assess need for PCI in NSTEMI?
Grace score
What are the complications of MI?
Heart failure DREAD Death Rupture of heart septum or papillary muscles Oedema (heart failure) arrhythmia and aneurysm Dresslers syndrome
Describe dressers syndrome
post MI syndrome
usually 2-3 weeks after
localised immune response leads to pericarditis
How does Dresslers present?
pleuritic chest pain
low grade fever
pericardial rub can cause pericardial effusion and rarely tamponade
How is dressers diagnosed?
ECG (global ST elevation and T wave inversion)
echo (pericardial effusion)
and raised CRP and ESR
How is dressers managed?
NSAIDs and steroids if severe
may need pericardiocentesis
describe secondary prevention medical management after ACS
aspirin 75mg once daily Another anti-platelet for 12 months Atorvastatin 80mg ACEi (ramipril) Atenolol Aldosterone antagonist for those with clinical heart failure (eplerenone titrated to 50mg once daily)
What are the lifestyle secondary prevention measures post ACS?
stop smoking reduce alcohol consumption mediterranean diet cardiac rehab optimise treatment for other medical conditions
What is a type 1 MI?
traditional due to coronary event
What is a type 2 MI?
ischaemia secondary to increased demand or reduced supply of oxygen (e.g. anaemia, tachycardia)
What is a type 3 MI?
sudden cardiac death or cardiac arrest suggestive of an ischaemic evetn
What is a type 4 MI?
MI associated with PCI / coronary stunting / CABG
