Acute Coronary Syndrome - Intro, Clinical Features, Management, Prognosis, Complications, Secondary Prevention Flashcards
What are the three main presentations under the umbrella term Acute Coronary Syndrome (ACS)?
ST elevation myocardial infarction (STEMI)
Non-ST elevation myocardial infarction (NSTEMI)
Unstable angina
How does ischaemic heart disease develop?
Ischaemic heart disease develops from the gradual build-up of fatty plaques in the coronary arteries, leading to either gradual narrowing (causing angina) or sudden plaque rupture (causing myocardial infarction).
List two main complications of atherosclerosis in coronary arteries.
Reduced blood flow causing angina
Plaque rupture causing myocardial infarction
What are the key unmodifiable and modifiable risk factors for developing ischaemic heart disease?
Unmodifiable:
Increasing age
Male gender
Family history
Modifiable:
Smoking
Diabetes mellitus
Hypertension
Hypercholesterolaemia
Obesity
What are the classic symptoms of Acute Coronary Syndrome (ACS)?
Central/left-sided chest pain, often described as heavy or constricting
Pain may radiate to the jaw or left arm
Dyspnoea
Sweating
Nausea and vomiting
What are the two most important investigations when assessing a patient with suspected ACS?
ECG
Cardiac markers (e.g., troponin)
What does the MONA mnemonic stand for in the treatment of ACS?
Morphine
Oxygen (if O2 saturations < 94%)
Nitrates
Aspirin
What is the preferred method of revascularization for patients with a STEMI?
Percutaneous Coronary Intervention (PCI), which involves angioplasty and possibly stenting to reopen the blocked artery.
What long-term medications are typically prescribed for secondary prevention after an ACS?
Aspirin
Second antiplatelet (e.g., clopidogrel)
Beta-blocker
ACE inhibitor
Statin
What is the role of GRACE score in managing patients with NSTEMI?
For risk stratification to decide the need and timing of coronary angiography during the admission for patients with NSTEMI.
What are some atypical presentations of Acute Coronary Syndrome (ACS), and which patient groups are more likely to experience them?
Atypical presentations of ACS, such as the absence of chest pain, are more common in elderly patients, diabetics, and females. These patients may present with dyspnoea, nausea, vomiting, or sweating instead.
What symptom commonly accompanies chest pain in Acute Coronary Syndrome (ACS) and might indicate a more severe cardiac event?
Palpitations often accompany chest pain in ACS and might suggest a more severe cardiac event, such as a myocardial infarction.
What should be considered if an elderly, diabetic, or female patient presents with unexplained dyspnoea and vague discomfort?
Consider the possibility of an atypical presentation of ACS in elderly, diabetic, or female patients presenting with unexplained dyspnoea and vague discomfort, even in the absence of typical chest pain.
What are the criteria for diagnosing STEMI based on ECG findings?
Symptoms: Consistent with ACS
Persistent ECG changes:
Men < 40 years: ≥ 2.5mm ST elevation in V2-3
Men > 40 years: ≥ 2.0mm ST elevation in V2-3
Women: 1.5mm ST elevation in V2-3
All patients: 1mm ST elevation in other leads or new LBBB
When should Percutaneous Coronary Intervention (PCI) be considered for STEMI?
Timing: Within 12 hours of symptom onset
PCI preferred:
- If PCI can be done within 120 minutes of when fibrinolysis could have been given
- Considered after 12 hours if ongoing ischemia
Stents: Drug-eluting stents are used
