Acute Coronary Syndrome And Angioplasty Flashcards
Name 3 conditions that ACS covers
Unstable angina
Non ST-segment-elevation myocardial infarction (NSTEMI) - doesn’t show up on an ECG
ST-segment-elevation myocardial infarction (STEMI) - shows on the ECG
What are the signs and symptoms of myocardial ischaemia?
Central chest pain
Crushing or constricting in nature
Persists for more than 15 minutes
Pain may also be present in the shoulders, upper abdo or referred to the neck/jaw/arm
What other signs and symptoms can feature in myocardial ischaemia?
Nausea and vomiting Marked sweating Breathlessness Pallor Combination of chest pain associated with haemodynamic instability (dropped blood pressure) Feeling of impending doom Clammy and cold to touch
What patients are more prone to myocardial ischaemia?
Younger (25-40yrs) - Asian males
Older generation (over 75yrs)
Unwell diabetics
Unwell female patients
Explain what Acute Coronary Syndrome (ACS) is?
ACS occurs when there is an abrupt reduction (narrowing) or cessation (stopping) in blood supply to the muscle of the heart, leading to myocardial ischaemia (lack of oxygen to tissue)
What are the signs and symptoms of Unstable angina?
Angina of effort increasing frequency and provoked by less exertion
Angina occurring recurrently and unpredictably - not specific to exercise
Unprovoked and prolonged episode of chest pain - no ECG evidence of MI (myocardial infarction)
Woke up with pain
What is Acute Myocardial Infarction?
Cardiac muscle is deprived of coronary blood flow enough to cause portions of the muscle to die.
What can slow the blood flow through the coronary vessels?
Thrombus in coronary artery
Spasm in coronary artery
Reduced overall blood flow i.e PE (pulmonary embolism) arrhythmia (not normal heart rhythm)
Shock
What are the aims in ACS?
Reduction of myocardial necrosis in patients with on going infarction - lost minutes = Lost heart muscle
Get the patient to hospital quickly
Prevention of major adverse cardiac events
Rapid defibrillation when ventricular fibrillation (V Fib) occurs
What do all ACS’s have in common?
All have sudden ischaemia
Can not be differentiated in the first few hours
All have the same initiating signs and symptoms
What are the factors that can increase infarction?
Plaque rupture Myocardial oxygen demand Coronary vasoconstriction Thrombus formation Collateral circulation
Diagnosis of ACS
Clinical presentation - signs and symptoms
ECG
Imaging evidence of loss of viable myocardium (ultra sound)
Cardiac markers
Raised blood sugars if not diabetic (above 9)
When would you take a patient to a Heart Attack Centre (cathlab)?
Patients with chest pain or tightness suggestive of ACS that is sustained for more than 20 mins and has occurred at any time within the last 9 minutes. This includes indigestion type pain.
When would you take a patient into a Heart Attack Centre?
When 12 lead ECG showing clear ST segment elevation
ROSC (return of spontaneous circulation) in whom the post arrest 12 lead ECG shows clear ST elevation regardless of GCS (consciousness level)
New LBBB (left bundle branch block)
Silent MI or MI with atypical presentation
High risk ACS
What is the ACS Care Bundle
Aspirin GTN 2 pain scores (pre and post intervention) Analgesia (entonox) Don't forget a BM!
What are the therapeutic effects of Aspirin?
Anti-platelet action (like Teflon) which reduces clot formation
Analgesic (pain killer), anti-pyretic (brings temperature down) and anti-inflammatory
What are the indications for giving Aspirin?
Clinical or ECG evidence suggestive of MI or ischaemia
What are the contraindications for giving Aspirin?
Known aspirin allergy or sensitivity
Children under 16 years
Active gastrointestinal (GI) bleeding (ulcer)
Haemophilia or other known clotting disorders
Severe hepatic disease
What is the dose and how do you administer aspirin?
300mg tablet
Chew it
What are the side effects of Aspirin?
Gastric bleeding
Wheezing in some asthmatics
What patients can you still give Aspirin to, as the benefits outweigh the potential risks?
Asthma Pregnancy Kidney or liver failure Gastric or duodenal ulcer Current treatment with anticoagulants
What are the therapeutic effects of Glyceryl Trinitrate (GTN)?
Dilation of coronary arteries/relief of coronary spasm
Dilation of systemic veins resulting in lower preload
Reduced blood pressure
What are the indications of GTN?
Cardiac chest pain due to angina or MI
Acute cardio genie pulmonary oedema
What are the contraindications of GTN?
Hypotension Hypovolaemia Head trauma Cerebral haemorrhage Sidenafil (viagra) or related drug taken within 24 hours Unconscious patients
What are the side effects of GTN?
Throbbing headache Flushing Dizziness Postural hypotension Tachycardia
What is the dose and how do you administer GTN?
1 x 400mcg spray
Sprayed under the tongue
The effect of the first dose should be assessed over 5 mins, further doses can be administered provided the systolic blood pressure is less than 90mmHg
