Acute coronary syndrome - diagnosis, management Flashcards
how would you define stable angina?
If myocardial blood flow reduced when increased demand ischaemia occurs
what does plaque disruption lead to?
Atherothrombosis Formation
is atherothrombosis predictable or unpredictable?
unpredictable
what is acute coronary syndrome?
term used to describe a range of conditions associated with sudden, reduced blood flow to the heart.
what conditions come under acute coronary syndrome?
unstable angina
non ST elevated myocardial infarction
ST elevated MI
sudden cardiac death
when does ACS give out symptoms?
will almost always give symptoms at rest in contrast to stable angina which is always on exertion
what are risk factors for acute coronary syndrome?
Non-modifiable Age, gender, creed, family history & genetic factors. Previous angina, cardiac events or interventions. Modifiable Smoking Diabetes mellitus Hyperlipidaemia Hypertension Lifestyle- exercise & diet
symptoms of unstable angia and NSTEMI
Breathlessness alone +/- signs of heart failure
Nausea & vomiting +/- other autonomic symptoms
Epigastric pain +/- recent onset indigestion
whats the immediate treatment for unstable anigina and NSTEMI?
Immediate treatment: First ABCDE approach, then MONA Morphine (or diamorphine) Oxygen Nitroglycerine (GTN spray or tablet) Aspirin 300 mg orally (crush/chew)
what other kind of treatment is there?
Anti-platelet therapy Anti-thrombotic therapy Other medical therapy eg B blockers and statins Coronary revascularisation
whats the treatment path for unstable angina and NSTEMI?
Most patients stay in hospital for 2-7 days.
Not all patients will have angiography, and not all who an angio. will need or have revascularisation.
Decisions more difficult in the elderly and/or those with important co-morbidities.
Many not reviewed after hospital discharge, some are for further decision making.
what is STEMI?
very serious type of heart attack during which one of the heart’s major arteries (one of the arteries that supplies oxygen and nutrient-rich blood to the heart muscle) is blocked
what is the treatment for STEMI?
Primary PCI Fibrinolytic therapy Fibrinolytic therapy and bleeding Secondary prevention In-patient investigations
what is sudden cardiac death?
Irregular, ineffectual ventricular fibrillating activity
Multiple wavelets of electrical activity.
what is the only effective treatment for ventricular fibrillation arrest?
defibrilation
whats the time scale for best chance for success in ressucitating a patient?
3-4 mins
what are the life-threatening MI complications?
Mechanical complications
Ventricular arrhythmic complications
Both need urgent intervention and their proper diagnosis and early management is a necessity.
Later complication less threatening but still needs treatment:
LV thrombus.
what is the most dramatic complication of MI?
Tearing or rupture of infarcted myocardium.
what are the three main complications of tearing or rupturing infarcted myocardium?
Free Wall Rupture 10-12%
Papillary Muscle Rupture 1-2%
Rupture of IVS (VSD) 1-2%
what can free wall rupture lead to?
Leads to haemopericardium and acute tamponade
what is free wall rupture more common in?
Elderly, females, HBP & anterior MI.
what should you initially do if you habe a patient with free wall tear?
If possible urgent echo, pericardiocentesis and drainage with pigtail catheter.
who more commonly has septal wall rupture?
Elderly, females, HBP, those not thrombolysed
symptoms of papillary muscle rupture and vsd?
Sudden severe breathlessness (MVR)
Autonomic activation eg sweating, nausea & vomiting
Chest pain
signs of papillary muscle rupture and vsd
Shock, tachycardia, pulmonary oedema New harsh systolic murmur VSD - LSE right chest (always) MV rupture - apex back (can be absent) Right parasternal heave Palpable thrill, elevated JVP.
what are investigations of MI
Echo
Cath lab
