Acute Coronary Syndrome (ACS) Flashcards
What is ACS an umbrella term for?
Unstable angina, NSTEMI, STEMI
Unstable angina
Occlusion?
Infarction?
ECG?
Troponins, creatine, kinase MB?
Partial occlusion of a minor coronary artery
No -ischemia only
Normal - may show some ST depression/ T wave inversion
Normal
NSTEMI
Occlusion?
Infarction?
ECG?
Troponins, creatine, kinase MB?
Partial of a major CA/ total of a minor CA
Sub endothelial infarct (areas far away from CA - occlusion dies)
ST depression + T wave inversion
No Q waves
Elevated (high with infarction)
STEMI
Occlusion?
Infarction?
ECG?
Troponins, creatine, kinase MB?
Total of a major CA
Transmural infarction
ST segment elevation in local leads (2+)
Q waves (pathological after some time)
Elevated (high with infarction)
What are ECG changes after MI?
Hyper acute T waves
Pathologically deep Q waves
LBBB
Which is a good bio marker (troponin, creatine kinase MB)? And when?
Troponin has shorter half life than CK MB therefore CK MB better bio marker after a few days
What are the 2 types of MI?
T1 = IHD (most common)
T2 = increased demand or CA vasospasm
Symptoms of ACS
Same as stable angina, but pain at rest, prolonged with no relief ‘impending doom’, palpitations & symptoms more severe
Diagnosis of ACS
ECG
Bio markers (troponin, myoglobin, CK)
CT coronary angiogram - show extent of occlusion
Treatment for acute ACS?
MONAC
Morphine
O2 (if stats <94%) (88-92% of COPD)
Nitrates (GTN)
Aspirin (300mg)
Clopidogrel (75mg) - dual anti platelet
What Is the treatment for NSTEMI/ unstable angina?
Grace score (mortality risk of patient with ACS from MI - 6months to 3 years)
Low risk - monitor
High risk - immediate angiogram + consider PCI
Treatment for STEMI?
PCI - if within 12 hours of symptoms onset / <2 hours of first medical contact
Thrombolysis - Alteplase if >12 hours symptoms, then consider PCI if this fails
(clot buster - activates plasmin -acts as tissue Pa; plasmin eats fibrin)
Long term prevention for ACS
Which 5 drugs?
Beta blocker (life)
Aspirin - initial loading dose 300mg - long term 75mg (life)
Atorvastatin - 80mg (life)
ACE-i (life)
Clopidogrel (75mg for 12 months)
Acute complications (<2weeks) of ACE?
Heart failure due to vent fibrillation
Mitral incompetence
LV free wall rupture
Cardiogenic shock
Complications (>2 weeks) of ACE?
Dressler syndrome (autoimmune pericarditis), heart failure, LV aneurysm (heart literally becomes saggy)
