Acute coronary syndrome (includes biomarkers) Flashcards
acute coronary syndrome definition
syndrome of reduction/occlusion to blood supply of the heart
acute coronary syndrome ( 3 x diseases )
- unstable angina 2. non ST elevation MI 3. ST elevation MI
unstable angina ( 6)
- ischaemia / chest pain at rest 2. 70% degree of stenosis 3. subendocardial ischaemia 4. normal biomarkers 5. normal ECG 6. can progress to STEMI/NSTEMI
non ST elevation MI (6)
- subendocardial infarction - infarction distally and ischemia proximal to artery supply 2. 80-90% stenosis 3. atherosclerotic plaque could rupture and thrombus may form 4. change in bio markers 5. ST segment depression 6. can progress to STEMI
ST segment elevation
- transmural infarction - necrosis of all layers of the heart 2. thrombus completely obstructs the coronary artery ( LAD -> RCA–> lEFT CIRCUMFLEX ) 3. change in biomarkers 4. ECG - ST segment elevation 5. Damage of papillary muscles - ischaemia can cause damage and result in mitral regurg/prolapse 6. Check for left bundle branch block - infarction of left septum of the heart where left bundle branch goes through ( V1 - W, V2 - M )
Symptoms of Acute coronary syndrome (3)
- Central crushing chest pain referred to C7 - T4 towards left arm and jaw 2. Diapheresis - sweating (sympathetic nervous system) 3. Nausea + vomiting (parasympathetic )
Troponin
- cTnT and cTnI ( more specific ) 2. elevated levels within the blood within 2 -4 ours 3. peaks at 18 - 24 hours 4. stays elevated for 10 - 14 days
Cardiac troponins are raised in (7)
- MI 2. HEART FAILURE 3. TRAUMA 4. HYPERTENSION 5. SEPSIS 6. MYOCARDITIS 7. PE
Creatinine kinase
- Creatinine Kinase (MB) is found in cardiac muscle 2. CK itself is non specific between muscle and brain 2.increase 4 - 6 hours 3. peak level 24 hours 4. remains elevated 2 - 3 days 3. helpful for reinfarction - happens in 10% of MI
Myoglobin
- increase in 1 hour 2. peak level 2 - 12 hours 3. persistence 24 - 36 hours
ECG changes in an MI
- ST segment elevation - immediately 2. Pathological Q wave + T wave inversion + ST elevation - 1 week later 3. Pathological Q wave remains - weeks to months sign of previous MI
criteria for diagnosing MI (5)
- detect cardiac biomarkers risking/falling and atleast one of the following 2. symptoms of ischaemia 3/ ECG changed ( new ST-W changes or new LBB) 4. Development of pathological Q wave in the ECG 5. Imaging shows loss of viable myocardium / new regional wall abnormality
Management for ACS ( immediate )
- M -orphine/ IV opions ( Pain relief) 2. Oxygen - if O2 sats < 93% 3. Asprin /Clopinagril - anti platelet 4. Nitrates - vasodilation and increase oxygen low to heart
Anterior MI
- V1 - V4 lead changes 2. Left anterior descending occluded
Anteroapical
- V3 - V4 2. Distal LAD
Anteroseptal
- V1 and V2 2. LAD
Anterolateral MI
- I, aVL, V5, V6 2. Circumflex artery
Inferior MI
- II, II aVF
Treatment for MI
- Gold standard - Primary PCI ( stent ) to allow muscle to be reperfused 2. Thrombolysis - break down clot in the aryert
HEART SCORE
- H istory (+2 - highly suspicious/+1 moderately sus/0 - non sus ) 2. ECG ( + 2 sig ST depression/1 - non specific/) 3. Age - +2 > 65/+1 45-65 4. Risk factors - Chol/HTN/DM/Smokers/Obesity 5. Troponin ( +2 3 x normal/ +1 1 -2 x normal )
Management for ACS (non immediate )
- Anti coagulant 2. Betal blockers 3. Ace inhibitors)
(3) types of troponin

What are (2) cardiac troponins?
Cardiac troponins: cTnT and cTnI -> they differ from skeletal muscle troponin structurally
*cTNI is more cardio-specific
Possible causes of raise in cardiac troponin
- MI
- HF
- Trauma
- Hypertension
- Sepsis
- Hypothyroidism
- Renal impairments
- Myocarditis
- PE
- many others…
What diagnosis are cardiac troponins used for?
ACS
Diagnostic criteria of MI
Detection of change in cardiac biomarkers (raise of troponin) + at least one of the
following (evidence of myocardial ischaemia) :
- symptoms of ischaemia
- ECG changes indicative of new ischaemia (new ST-T changes or new LBBB)
- Pathological Q wave changes in ECG
- Imaging evidence of new loss of viable myocardium or new regional wall motion
abnormality