Acute Coronary Syndrome (ACS) (UA + MI)

Question 1

Background

Answer 1

ACS includes unstable angina and Myocardial infarctions like (STEMI, NSTEMI)

Difference between the 3:
STEMI = ST elevation
NSTEMI = Troponin positive (showing heart damage)
Unstable angina = Troponin negative.

STEMI is full blockage of major coronary artery.
NSTEMI and UA are partial/intermittent blockage of major artery.
- Intermittent meaning a plaque ruptured making a blood clot (thrombus) that blocked smaller branches of the major artery. This still causes Myocardial damage and is NSETMI.
- Partial - thrombus or plaque partial blocks a artery. No Myocardial damage occurs and there is risk of full STEMI.

Question 2

Signs and symptoms

Answer 2

• Crushing central chest pain/tightness or discomfort (pain may also occur in the arms, shoulders, throat, jaw, teeth, back or upper abdomen)
• Breathlessness
• Sweating
  All 3 types share these symptoms.

STEMI
Symptoms more severe last >30 min and isn’t relieved by GTN/Rest
Other stemi symptoms: dyspnoea, fear, pallor, sweating (clammy feeling), anxiety, vasoconstriction (peripheral) and shock.

NSTEMI
Symptoms develop over 24-72 or more hours.

Unstable angina
Frequent attacks of angina for the 1st time OR sudden worsening of previously stable angina OR recurrent angina at rest OR sudden onset of severe chest pain at rest.
Symptoms develop over 24-72 or more hours.

Other shared symptoms:
Back pain, abdominal pain, syncope, pain free SOB.

Differential diagnosis
Key feature PAIN responds to GTN within 2 to 5 minutes indicates its STABLE angina.

Question 3

ECG and troponin levels