Acute Coronary Syndrome - NSTEMI, STEMI, Unstable Angina Flashcards
Features of acute coronary syndrome (ACS)
chest pain
classically on the left side of the chest
may radiate to the left arm or neck
this may not always be present. Being elderly, diabetic or female makes an atypical presentation more likely
dyspnoea
nausea and vomiting
sweating
palpitations
What medication is contraindicated in patients with hypotension (< 90 mmHg)
Nitrates
Nitrates have vasodilator effects, including peripheral venodilating properties which result in decreased venous return, ultimately causing hypotension.
contraindications of nitrates are bradycardia (< 50 beats per minute) and history of recent (24-48 hours) phosphodiesterase-5 inhibitor use (sildenafil, tadalafil)
How would a diabetic ptx present MI?
They can present MI without chest pain.
Differentiate NSTEMI and UA?
NSTEMI will have rising levels of Troponin
What measure the risk of ACS?
Grace Score
What does GRACE score involve?
Age
HR
Sys BP
Creatinine
Cardiac Rest on Admission
ST Segment deviation
Abdominal Cardiac Enzyme
Differentiate ACS and Prinzmetal Angina
Unstable angina and NSTEMI have similar clinical features.
The best way to differentiate between these two conditions is to perform serial high-sensitivity troponin tests and to observe for any rise or fall in troponin level.
Elevation in troponin level points towards an NSTEMI as this confirms the diagnosis of an infarction.
Prinzmetal angina is unlikely in this patient as it normally occurs in the younger population and in smokers. It also tends to occur early in the morning or at sleep.
ECG will normally show an ST-elevation in Prinzmetal angina.
Stable angina occurs during exertion and is relieved after resting.
‘1-2-12’ Rule for STEMI
‘1-2-12’ Rule for STEMI
1 → Primary PCI is the #1 choice for STEMI if available.
2 → If transport to a PCI centre takes more than 2 hours (120 minutes), opt for thrombolysis.
12 → For symptom onset within the last 12 hours, primary PCI is still an option even if thrombolysis was given.
What should be offered to patients with ACS for long term?
BRATS:
Bisoprolol
Ramipril
Aspirin
Ticagrelor
Statin
An ECG taken by the paramedics demonstrates ST depression in leads II, III and aVF, as well as T-wave inversion.
Oxygen SAT - 98%
What should be given immediately?
Aspirin, Nitrates and Morphine
An ECG taken by the paramedics demonstrates ST depression in leads II, III and aVF, as well as T-wave inversion.
Oxygen SAT - 91%
What should be given immediately?
Aspirin, Nitrates, Morphine and Oxygen
NSTEMI management, what is it and whats the duration of admission?
patients with a GRACE score > 3% should have coronary angiography within 72 hours of admission
