Acute Coronary Syndrome Flashcards
what are the three types of ACS
unstable angina
ST elevation MI
Non-ST elevation MI
What causes ACS
thrombus from atherosclerotic plaque blocking a coronary artery
symptoms of ACS
central chest pain - heavy, constricting pain may radiate to jaw/arm
dyspnoea
sweating
nausea + vomiting
key investigations for suspected ACS
12 lead ECG
troponin levels
features of STEMI on ECG
ST elevation corresponding to areas of ischaemia
- ECG here shows ST elevation in leads II, III, AvF
New LBBB is also considered an STEMI
features of an NSTEMI on ECG
ST depression
T wave inversion
Pathological Q waves - late sign suggesting deep infarct
- ECG here shows ST depression in leads I-III, AvF, V3-V6
Anterior MI affects which leads?
what vessel is occluded?
Anterior = V2 - V5
Left anterior descending
anterospetal MI affects which leads?
which vessel is occluded?
anteroseptal = V1 - V3
Left anterior descending
anterolateral MI affects which leads?
which vessel is occluded?
anterolateral = I, AvL, V4 - V6
left circumflex
inferior MI affects which leads?
which vessel is occluded?
inferior = II, III, AvF
right coronary
what are troponins?
are they specific to ACS?
proteins found in cardiac muscle - released due to myocardial ischaemia
Non- specific! can also be raised by:
- chronic renal failure
- sepsis
- myocarditis
- aortic dissection
- PE
acute management of ACS
MORPHINE
OXYGEN (If sats <94%)
NITRATES
ASPIRIN
+ CLOPIDOGREL / TICAGRELOR IN STEMI
(+ metoclopramide as anti-emetic)
Management of STEMI presenting
- within 2 hours
- over 2 hours
STEMI within 2 hours = PCI
STEMI >2 hours = thrombolysis with streptokinase
what score is used to assess risk of death/ repeat MI in NSTEMI patients
GRACE score
- high risk patients are considered for PCI within 4 days of admission
management of an NSTEMI
BETA BLOCKER (unless contraindicated)
ASPIRIN 300mg
TICAGREGLOR 180mg
MORPHINE
ANTICOAGULANT (LMWH e.g. fondaparineux, enoxaparin)
NITRATES
what is dresslers syndrome
pericarditis 2-3 weeks post MI
- Pleuritic chest pain that improves on sitting forward
- low grade fever, pericardial rub
ECG changes pericarditis
widespread saddle shaped ST elevation
imaging required for all patients with suspected pericarditis
transthoracic echo
tx of dresslers syndrome
NSAIDS
drugs for secondary prevention of MI
Aspirin 75mg
Antiplatelet e.g ticagreglor
Atorvastatin 80mg
ACE inhibitor
Atenolol
Aldosterone antagonist for those with HF e.g. eplerenone
lifestyle advice post MI
Stop smoking
reduce alcohol consumption
mediterranean diet
most common cause of death post MI
Ventricular fibrillation
persistent ST elevation + left ventricular failure post MI suggests what?
left ventricular aneurysm
- anticoagulate patient due to increased risk of stroke
a patient presenting 1-2 weeks post MI with heart failure secondary to cardiac tamponade (raised JVP, pulsus paradoxus, decreased heart sounds) suggests what?
left ventricular free wall rupture
- urgent pericardiocenteis + thoracotomy is required
what murmurs can occur following an MI
VSD – continous machinery murmur
Mitral reguary – pan systolic blowing murmur
how long do you have to wait before driving a car post MI
4 weeks
what marker is useful to look for re-infarction in MI
CK-MB
- returns to normal 2-3 days post infarcation so will be raised again if a secondary infarction occurs (unlike Troponins which can remain elevated for some time after the initial infarction)
why can heart block occur with an inferior MI?
Right coronary artery supplies AV node
- inferior MI occurs when there is a blockage in the right coronary
ECG changes in a posterior MI
ST depression + tall R waves in leads V1 - V3
