ACUTE CORONARY SYNDROME Flashcards
What is ACS?
A term used to describe a range of conditions associated with sudden, reduced blood flow to the heart
What are examples of ACS?
MI - heart attack - myocardial cell death, releasing troponin
ISCHAEMIA: Lack of blood supply +/- cell death
UNSTABLE ANGINA
What are the two types of MI?
STEMI: ST-segment elevation of new LBBB
NSTEMI: trop-positive ACS without ST-segment elevation
What causes ACS?
Build up of fatty deposits in and on sale of coronary arteries
Rupture of the plaques led to blood clot and decreased blood flow to the myocardium
Heart attack (MI) results of the oxygen supply to cells is too low
What are the symptoms of ACS?
Angina
Radiation of pain to shoulder, arms, jaw or neck
Nausea or vomiting
Indigestion
Dyspnoea
Syncope
Fatigue
Palpitations
Low-grade fever
What are signs of ACS?
Anxiety Pallor Diaphoresis High of low pulse and BP S4 Signs of Heart failure Pansystolic murmur
What are signs of Heart Failure?
JVP raised
s3
Basal crepitations
What are risk factors of ACS?
Age (>65) Hypertension High cholesterol Cigarette smoking Lack of physical activity Unhealthy diet Obesity Diabetes FHx of heart disease or stroke
What are the top differentials for ACS?
GORD PNEUMOTHORAX PE AORTIC DISSECTION MYOCARDITIS, PERICARDITIS CHRONIC RENAL FAILURE
Which blood test would you do for investigating ACS?
FBC: anaemia
UE: exclude chronic liver failure
BLOOD GLUCOSE: risk factors
LIPID PROFILE: risk factors
CARDIAC ENZYME: gold standard Trop I and T high
Which imaging is done for ACS?
CXR: cardiomegaly, pulmonary oedema or a widened mediastinum (exclude conditions)
CT CORONARY ANGIOGRAM: assess coronary artery disease
ECG
What would be your ECG results for STEMI or NSTEMI?
STEMI: ST-segment elevation, Tall F waves, New LBBB
NSTEMI: ST depression, T wave inversion, could also be normal
How are the symptoms of ACS controlled?
GTN
Titrated Morphine
How are the ACS risk factors modified?
Stop smoking
Treat diabetes, hypertension and hyperlipidaemia
Advise diet high in oily fish, fruit and veg, and fibre and low in saturated fats
Daily exercise
Which medications are used to manage ACS?
Aspirin + Clopidogrel: anti platelet drugs
Lanzoprazole: PPI for gastric protection
Enoxaparin: LMWH anti-coagulate
Bisoprolol: Beta blocker
Lisinopril: ACEi
Atorvastatin: decrease cholesterol
