Acute coronary syndrome summary Flashcards
Causes and Pathophysiology of Acute coronary syndrome
Plaque development, stenosis, cap attacked by inflammation, rupture and clot. Often it is the less stenotic plaques
Describe clinical syndromes of Acute coronary syndrome
ACS = Instable angina (no enzymes), NSTEMI (enzymes present), STEMI
NSTEMI: some infarct/death but not transmural. Not 100% block or 100% of time
STEMI: Transmural ischemia. 100% blocked, 100% of time. Dies from inside out at distal part of vessel.
Symptoms of MI
History of Myocardial Infarction, diabetes, HTN, High lipids
Pain in chest or arm
Character of pain (not sharp/stabbing, pleuritic, positional or made by palpating)
Chest pain radiation: R Shoulder, R Arm, L Arm, Both Arms
Chest pain most important symptom
Nausea or vomiting
Diaphoresis
SOB, dizzy/weak/syncope
Signs and Physical findings of MI
Hypotension (sBP ≤ 80 mmHg)
3rd / 4th Heart sounds
Pulmonary crackles
Chest pain reproduced with palpation
Key lab tests and findings of MI
Biomarkers: troponin (not only in Acute MI) and CK EKG -ST-elevation: transmural infarct. Any ST-segment elevation -New conduction defect -New ST elevation (≥1 mm) -New Q wave -New T wave inversion
Tx for MI
Rapid reperfusion!
Stent/Balloon: less risks but need setup, >3h since onset
Fibrinolysis: best if <3h, if cath lab not possible
Prevention (1º or 2º) of MI
A—2 anti-platelets: ASA + Clopidogrel (sometimes iv. G2b3a inhibitors)
A—anti-coagulants: Heparin, Fondaparinux (anti-Xa), bivalrudin (anti-thrombin)
A—ACE inhibitors / ARB’s much more important
B—ß-blockers & BP control more important (but avoid low BP!)
C—Cholesterol crucial, LDL < 10mM (MI stress -> ↑glucose)
E—End smoking! 2 x risk if don’t quit
E—Exercise: Live longer / better
Post MI management
Monitor risks in CCU: Mechanical (myocardium is mush - not working or bulge/burst), electrical (arrhythmias), arterial (reinfarction, post-MI instable angina)
