Acute Coronary Syndrome Flashcards
Which ward should patient’s diagnosed with ACS be admitted to as soon as possible?
Coronary Care Unit - ccu
What causes ACS?
atherosclerosis - plaque ruptures and thrombus formation
What should be considered when proving information and support to a patient with ACS?
• Patients will be anxious
• A warm welcome from staff is important to establish a
therapeutic relationship
- Sufficient information to understand their diagnosis and treatment plan
- A personalised approach
- Managing realistic expectations from patient & family
- If chest pain assess/ Differential diagnosis
When treating a patient with chest pain what should you treat for first?
The most serious case - myocardial infarction
What protein causes localised vassoconstriction?
Thromboxane A2
What is Acute coronary syndrome (ACS)?
An acute coronary syndrome represents a
combination of clinical signs and symptoms that
result from myocardial ischaemia
What would be the condition of a person with a stable intact lesion?
stable angina
What would be the condition of a patient with breached endothelium with or without superimposed fibrin clot and
coronary spasm?
ustable angina
What would be the condition of a patient with Plaque rupture with superimposed fibrin clot leading to total coronary
occlusion and coronary spasm?
myocardial infarction
What factors make a thorough cardiac assessment?
- Patients require a detailed clinical assessment including ABCDE
- ECG
• Repeat 12 lead ECGS if diagnostic
uncertainty or any change in clinical status
• Continuous cardiac monitoring
When presented with a patint with chest pain what type of questions should be considerdered or factors?
- History of current problem
- Onset
- What makes symptoms better/worse
- Maybe stable angina
- ACS
- Unstable angina
- Acute myocardial infarction
Suggest some contributory factors for ACS
- Age
- S
- FH or CHD
- Prior hx IHD
- Diabetes mellitus
- Renal impairment
- High risk features
- Worsening angina
- Prolonged pain> 20mins in duration
- Pulmonary oedema
- Hypotension
- Arrhythmias
Suggest some risk factors for ACS
- Smoking – mortality 60% higher in smokers
- Hypercholestraemia
- Diet – 1/3 of men & women consume 5 portions fruit & veg
- Sedentary lifestyle 5 x 30mins week
- Alcohol consumption
- Hypertension
- Obesity
- Socioeconomic deprivation
- Diabetes
How does alcohol consumption increase risk of ACS?
induces slight hypertension which increases risk of damage to endothlium
What protective mechanism do pre-menopusal woman have against ACS?
oestrogen
What mnemonic should be used to assess patient chest pain?
PQRST
What does PQRST stand for?
P = Precipitating factors Q = Qualitative factors R = Region & Radiation S = Severity & associated symptoms T = Timing
What would assessment would you expect from an unstable angina?
P = Q = Pressing, squeezing R = Across Chest,jaw, shoulders, back, arms S = Mild to moderate T = 1-20mins
What would assessment would you expect from a Myocardial infarction?
P = Q = Tight, heavy, burning R = Across Chest,jaw, shoulders, back, arms S = Not always severe T = 20 mins-several hrs
What would assessment would you expect from a dissecting aortic aneurysm?
P = Q = Ripping, tearing R = Anterior chest,radiating to neck,back or abdomen S = Very severe T = Abrupt onset Pesistent for hrs
When assessing the type of chest pain what should you ask the patient?
- Pain
- What’s the position of pain
- Radiation
- Quality
- Circumstances
- Time span
- Relief
- Pain score
what obs should be assessed in particular in a patient with chest pain?
- Blood pressure
- Heart rate
- Temperature
What scale is used to assess severety for patients with heat failiure?
New York Heart association classification of heart failiure
When visually inspecting a patient,what factors you consider
• Does the patient look unwell • Colour • Signs of shock • Weight loss • Look at the face – pain, xanthelasma, thyroid disease • Hands • Chest – breathing • Oedema
What symptoms would you expect from a atient with class II heart failiure?
Slight limitation of physical activity. Comfortable at rest. Ordinary physical activity results in fatigue, palpitation, dyspnea (shortness of breath)
In what groups might you find an atypical presentation of ACS?
- Women
- Elderly
- Diabetics
- Ethnic minority groups
List some common symptoms of ACS?
- Chest pain
- Hypotension
- Autonomic nervous system activation
- Pallor
- Sweating
- Rhythm disturbances
What biochemical marker sugeest a myocardial infarction?
Cardiac troponins released after myocardial
damage
• Troponin I & troponin T are markers of
myocardial necrosis
• Cardiac specific
• Also take 3-4hrs to detect but are elevated
for 1-2 weeks
What does a basic ECG record?
• It is a simple recording of the electrical activity of cardiac cells during contraction and relaxation of the heart
How do Basic ECG work?
The electrical currents are conducted through the body tissues and can be picked
up by electrodes attached to the skin
These are amplified and displayed on paper
or a monitor screen.
What is the name of triangle formed from the 3 leads in an ECG?
Einthoven’s triangle
What wave represent atrial contraction?
the P-wave
what wave represent ventricular contraction?
qrs complex
What is an ST elevation?
trace in the ST segment is abnormally high above the baseline
What does the ST segment show?
reflects pause between the end of ventricular depolarisation and start of ventricular
repolarisation.
what is another word for the baseline on an ECG?
isoelectric line
What could ST segment elevation be caused by?
MI; non-ischaemic causes:
hyperkalaemia;
What could ST segment depression be caused by?
MI, hypokalaemia; hypothermia.
What secondary prevention methods are put in place for patients who have had an ACU
- LIFESTYLE
- CARDIAC REHABILITATION
- DRUG THERAPY
- CARDIOLOGIST REVIEW
What medication is given to ptients following an ACU?
• Antiplatelet therapy: Aspirin 75 mg OD indefinitely
• Clopidogrel 300mg/75mg for 12 months (NSTEMI)
at least 4 weeks for STEMI unless other indications
for dual antiplatelet therapy
OR
• Tigacrelor 180mg/90,g BD for 12 months inhibits
platelet aggregation & thrombus formation
• Maybe PPI Omeprazole
when should statins be given?
at night
When should b blockers be given?
as soon as patient clinically
stable
What are the 4 types of Anti-hypertensives?
Beta-Blockers
ACE inhibitors
Aldosterone affecting medication?
Calcium antagonists
When suffering from on MI which arm is likely to feel pain?
left arm
What happen during a PEA non-shockable rhythm?
When there is a normal ECG but no cardiac output
Which rhythms are non-shockable?
PEA and asystole
Which rhythms are shockable?
Ventricular fibrillation and pulseless ventricular tachycardia
According to the New York Association classification of heart failiure how would one class an ACS patient with no limitation of physical activity,no undue fatigue, palpitation or dyspnea?
Class 1 Mild
How does Hyperkalaemia affect st on ECG?
cauess st elevation
How does Hypokalaia affect st on ECG?
caueses st depression
