acute coronary syndrome (ACS) Flashcards
angina presentation
substernal type of chest pain radiating to the neck, face and left arm
angina cause
insufficient oxygen supply to the heart muscle leading to ischaemia often due to atherosclerotic plaque build-up in coronary arteries
decreased oxygen supply consequences (2)
decreased perfusion pressure and decreased arterial oxygen content
increased oxygen demand consequences (4)
increased heart rate, increased preload, increased afterload, increased contractility
coronary artery diseases
diseases affecting the heart and coronary blood vessels often due to atherosclerosis and hypertension
CAD divisions (2)
stable angina and ACS
ACS divisions
unstable angina, NSTEMI, STEMI
stable angina pathology
stable fixed plaque covered by fibrous tissue
unstable angina pathology
plaque rupture and platelet aggregation
non-ST segment elevation myocardial infarction (NSTEMI) pathology
partial or incomplete blockage of coronary artery with plaque rupture
ST segment elevation myocardial infarction (STEMI) pathology
complete blockage of coronary artery often due to other precipitant with plaque rupture
CAD risks (6)
smoking, advanced age, diabetes, cholesterol, hypertension, family history
CAD symptoms (4)
angina, epigastric abdominal pain, nausea, diaphoresis
CAD diagnosis
12 lead ECG and cardiac biomarker test (troponins, CK-MB)
stable angina diagnosis
normal ECG during rest and T-wave inversion and/or ST depression during stress and negative troponin; obtain coronary angiogram for localising lesion
stable angina first line of treatment (5)
aspirin, beta blockers, calcium channel blockers, GTN, statins
stable angina second line of treatment
revascularisation
when to give second line of treatment for stable angina (3)
positive stress test, high risk lesions, ineffective therapy
revascularisation therapies
PCI/CABG and dual anti-platelet for a year
coronary angioplasty or PCI
catheter inserts balloon or stent to widen coronary artery (not used for LCA occlusion)
coronary artery bypass graft (CABG)
uses graft from other vessels to bypass lesion
unstable angina diagnosis
T-wave inversion and/or ST depression and negative troponin
NSTEMI diagnosis
T-wave inversion and/or ST depression and positive troponin
unstable angina or NSTEMI first line of treatment (6)
BATMAN = beta blockers, aspirin, dual anti-platelet therapy (+ heparin), morphine, statins, GTN
unstable angina or NSTEMI second line of treatment
revascularisation
when to give second line of treatment for unstable angina or NSTEMI (4)
TIMI score>3, cardiogenic shock, ventricular fibrillation, ineffective therapy
STEMI diagnosis
ST-segment elevation and positive troponin
vasospastic angina diagnosis
ST-segment elevation and negative troponin
STEMI first line of treatment
MONA = morphine, oxygen, GTN, aspirin; revascularisation (primary PCI or thrombolysis), ACE-Is, beta blockers, dual anti-platelet therapy, GTN, statins
reasons for using primary PCI
within 12 hours of symptom onset and will achieve repercussion within 90 mins arrival to ED; for patients meeting ECG criteria for urgent reperfusion
reasons for using thrombolysis
6-12 hours of symptom onset and will achieve repercussion within 90 mins arrival to ED if primary PCI is unavailable
STEMI second line of treatment (6)
ACE-Is, aldosterone antagonists, aspirin and another anti-platelet, atenolol, atorvastatin
non-pharmacological secondary preventions
limited alcohol, diabetes and hypertension control, diet and weight modifications, increased exercise, smoking cessation
primary PCI benefits
faster as does not administer fibrinolytic agents or GPIIb/IIIa inhibitors
rescue PCI
used if thrombolysis is not successful
pharmaco-invasive PCI
used 3-24 hours after thrombolysis
late pCI
used 12-24 hours in patients with ongoing ischaemia
myocardial infarction complications (4)
arrhythmia, acute heart failure, pericarditis, rupture syndrome
arrhythmia complications (3)
bradycardia, ventricular tachycardia, sudden cardiac death
acute heart failure complications (2)
multi-system organ failure and hypoxia or dyspnea
pericarditis complications
pleuritic chest pain and/or friction rub
rupture syndrome complications (3)
heart failure, cardiac tamponade, stroke
