Acute Coronary Syndrome Flashcards
what is acute coronary syndrome an umbrella term for
for acute presentation of coronary artery disease-STEMI, NSTEMI and unstable angina
while angina is predictable and safe, acute coronary syndrome is…
unpredictable and dangerous
what are the 3 stages of the pathophysiology of acute coronary syndrome
initiation: plaque ruptures (diff reasons inc thickness etc)
adhesion: platelets adhere to site of injury
activation: platelets activate & recruit other adhesion molecules to injury site
how is activation stage amplified
aggregation & activation triggers inflammatory cascade resulting in clotting cascade initiation
are men or women more vulnerable to MI
men
what are the 2 classes of MI
STEMI, NSETMI
what subtypes of STEMI are there
inferior [ST elevation in leads ii,iii & aVF] lateral [leads i, aVL, V5/6] anterior [leads V1-V6] anteroseptal [V1-V4] anterolateral [i. aVL, V1-V6]
what causes a NSTEMI
2y to ischaemia-not due to blockage;
- due to inc O2 demand e.g. LVH, tachy
- or dec O2 supply e.g. anaemia, hypotension
what is an MI
insufficient blood supply to heart leading to tissue death
aetiology of MI
smoking, HT, fhx, diabetes
presenting symptoms of MI
crushing central chest pain radiating to jaw and arm, sweating, dizziness, nausea
what is the difference between Mi presentation and angina
MI is prolonged, not relieved by rest/GTN
what are MI signs on an ECG
STEMI
- ST elevation: >1mm elevation in more than 1 adjacent limb leads
- T wave inversion show hx of MI/ tissue death
- pathological Q waves
- new LBBB (left bundle branch block)
NSTEMI
- ST depression
- T wave inversion
what enzymes and protein markers are elevated in an MI
cardiac enzymes: creatinine kinase
protein markers: troponin
what are the 2 types of troponin and what do they show
TnI & TnT show myocyte necrosis
for what is a GRACE score taken
NSTEMI
acute tx for STEMI?
- analgesia- morphine/anti-emetics
- anticoagulants- aspirin & ticagrelor
- O2 & GTN
- thrombolysis
- 1y angioplasty (PCI)
post MI tx?
statin, ACEI, dual anti-platelet therapy (aspirin & ticagrelor), BBs
complications of MI
arrhythmic: v.fib
structural: rupture (VSD), LV aneurysm, acute pericarditis, dressler’s
functional: acute ventricular failure, cardiogenic shock
NSTEMI tx?
- aspirin & clopidogrel
- heparin
- BBs
- group 2b/3a inhibitors
- surgery-PCI
what are the 2 types of cause of heart failure
- impaired LV filling (diastolic failure- Vs can’t relax and fill)
- impaired ejection of blood (systolic failure)
what are the 3 anatomical types of heart failure
LV failure; RV failure, acute heart failure
what causes LV failure
IHD, MI, cardiomyopathy, valvular disease
clinical features of LV failure?
dyspnoea, pulmonary oedema, tachycardia, basal crept., 3rd heart sound
