Acute Coronary Syndrome (pathology) Flashcards
What are acute coronary syndromes?
Collection of symptoms related to a problem with the coronary arteries
What causes acute coronary syndromes?
Caused by unstable coronary lesions
What are examples of acute coronary syndromes?
MI (STEMI and NSTEMI)
Unstable angina
Sudden cardiac death
What differentiates STEMI, NSTEMI and unstable angina? (ECG and troponin)
ST elevation = STEMI
No ST elevation + troponin = NSTEMI
No ST elevation + no high troponin = unstable angina
What are the 2 types if myocardial infarction?
Type 1:
Ischaemia + plaque rupture, erosion, fissuring, dissection = thrombosis
Type 2:
Supply demand imbalance —> ischaemia without thrombosis
What are the non-modifiable risk factors for Acute coronary syndrome (2)?
Male sex
Age
What are the modifiable risk factors for Acute coronary syndrome (7)?
Smoking Lifestyle (diet, exercise) Diabetes mellitus Hypertension Hyperlipidaemia Family history of premature heart disease Known heart disease
What are the symptoms for Acute coronary syndrome?
Ischaemic sounding chest pain:
- radiates to neck/arm - described as discomfort, tightness, heaviness - may be associated with nausea, sweating, SOB
What are the complications of MI?
Arrhythmic:
- Ventricular fibrillation
Mechanical:
- myocardial rupture —> cardiac tamponade
- acute ventricular septal defect
- papillary muscle rupture —> mitral regurgitation
CHECK FOR NEW MURMURS
What are the signs and symptoms for Acute coronary syndrome (4)?
Very unwell if STEMI May look fine once in hospital Check for: - HR, BP both arms Murmurs + crackles
What are the diagnosis/investigations for Acute coronary syndrome?
Bloods:
- cardiac biomarkers (troponin)
- Hb, kidney function, cholesterol
12 lead ECG:
- complete occlusion —> STEMI —> Q waves after 3 days
- partial occlusion —> ST depression, T wave inversion —> no Q waves after 3 days
What indicates there has been new ischaemic damage?
Cardiac cell death (+ve biomarkers - troponin) AND one of: - symptoms of ischaemia - new ECG changes - Evidence of coronary obstruction
What are the mechanical therapy/management options for STEMI (+NSTEMI)?
STEMI:
- Cath lab balloon & stents (PCI + coronary angiogram)
NSTEMI:
- angiogram within 48hrs
Thrombolysis given if can’t get to Cath lab within 2hrs
What are the pharmacological therapy/management options for STEMI?
Increase O2 supply:
- thrombolysis - good if given within 1-2hrs
- converts plasminogen into plasmin
- (fibrin specific alteplase)
&
- dual antiplatelet therapy (aspirin 300mg + ticagrelor 180mg)
What are the pharmacological therapy/management risks for STEMI?
Bleeding
- NO if recent stroke or intercranial bleed - caution if recent surgery, on warfarin, severe hypertension
What are the observation & treatment options for ACS?
Hospital admission
- if uncomplicated discharged in 2-3 days
Serial ECGs and cardiac monitor
IV access
O2 if low
Organise echo
Secondary prevention medication (statins, beta-blockers, anticoagulants)
What are the pharmacological therapy/management options for ACS?
B: beta-blockers (unless contraindicated)
A: aspirin (300mg start dose)
T: Ticagrelor (180mg start dose)
- clopidogrel (300mg) alternative if higher bleeding risk
M: Morphine titration to control pain
A: anticoagulant (Fondaparinux - unless high bleeding risk)
N: nitrates (e.g. GTN) to relieve coronary artery spasm
Give oxygen only if their saturations are dropping (<95%)
What are the secondary therapy/management options for ACS?
Aspirin (75mg)
Another antiplatelet (clopidogrel/ricagrelor) for up to 12 months
Statins
ACEi (ramipril)
Beta blocker (atenolol)
Aldosterone antagonists - if with heart failure (eplerenone)
