Acute Coronary Syndrome Flashcards
What is acute coronary syndrome
Pathology
Myocardial infarction - classification
Type 1 MI
Assessment of patient with acute coronary syndrome
History - This is critical.
ECG territories
Lead 1, aVL, V5 and V6 look at the lateral side of the heart
Lead 2, 3 and aVR look at the inferior side of the heart
V1. V2, V3 and V4 look at the anteroseptal side of the heart
Specifically Septum = V1 and V2 Anterior side of heart = V1-V6 Anterolateral = V3 - V6 High lateral = 1 and aVL
ECG can be variable - but can be a critical tool for identifying a STEMI
ST elevation - implies sudden occlusion - it can also persist long term as mark of LV aneurysm ( Q waves usually present)
ST depression - usually impress under supply of blood to myocardium but not sudden coronary occlusion - if in the anterior leads it can sometimes be due to sudden occlusion of vessel at the back of the heart (posterior STEMI)
T-Wave inversion - often implies under supply of blood to myocardium but not sudden coronary occlusion - there are other non ischaemia related causes
Heart block - various grades
Ventricular dysthythmia - VT, VF, Ectoics
ECG is a Critical tool for identifying a STEMI
Confirmation of a NSTEMI
ECG can be normal - can see -
Management of STEMI’s and NSTEMIs
For a STEMI - patient will need transfer to catheter labs for PCI - Percutaneous coronary intervention
Before this - can be given aspirin (anti inflammatory), given morphine to numb pain
Patient can also be given nitrate to act as a vasodilator if SBP is too hight, and oxygen if the O2 sats are below 92%
For a NSTEMI - Antiplatelets and antithrombotic
Invasive coronary angiogram and PCI
Establishes type of lesion and its location via angiogram - dye given in blood
For PCI -
Give
Management
Lifestyle changes
Low fat diet, regular exercise, low salt.
