Acute Coronary Syndromes Flashcards
define myocardial infarction (MI)
an underperfusion of the myocardium leading to death of the myocardial tissue
risk factors of MI
male sex FH of MI smoking hypertension hyperlipidaemia/hypercholesterolaemia obesity diabetes
types of MI
ST-elevation MI (STEMI)
non-ST-elevation MI (NSTEMI)
clinical features of MI
sudden central crushing chest pain radiation of pain to left arm, jaw and neck nausea sweating/clamminess dyspnoea worsened by exertion
atypical MI presentations
epigastric pain acute breathlessness palpitations acute confusion hyperglycaemia syncope
diagnosis of STEMI
cardiac chest pain
persistent ST segment elevation (>1mm in chest leads and >2mm in limb leads)
new LBBB
diagnosis of NSTEMI
cardiac chest pain
abnormal ECG with NO ST-elevation
raised troponin
investigations of MI
ECG
bloods (troponin, FBC, CRP, RFTs, lipids and glucose)
CXR
appropriate timing and testing of troponin levels in MI
at least 3hrs following pain
repeat 6-12hrs following onset of pain
coronary artery and area of myocardium affected if ST elevation in leads II, III and aVF
inferior myocardium and right coronary artery
coronary artery and area of myocardium affected if ST elevation in V1 + V2
septal myocardium and proximal left anterior descending coronary artery
coronary artery and area of myocardium affected if ST elevation in leads V3 +V4
anterior myocardium and left anterior descending artery
coronary artery and area of myocardium affected if ST elevation in leads V5 + V6
apex of the myocardium and distal LAD, left coronary and right coronary artery affected
coronary artery and area of myocardium affected if ST elevation in I and aVL leads
lateral myocardium and left circumflex artery
coronary artery and area of myocardium affected if V7 -V9 leads affected
posterolateral and RCA or left circumflex artery affected
management of a STEMI
oxygen therapy loading dose of PO aspirin 300mg sublingual GTN spray IV morphine PPCI
requirements for treatment with primary percutaneous coronary intervention (PPCI)
presenting within 12hrs of pain onset AND are <2hrs since first medical contact
management of an NSTEMI
oxygen therapy
loading dose of 300mg aspirin
sublingual GTN spray
IV morphine
antithrombin therapy (e.g. LMWH or fondaparinux)
if high mortality, angiogram within 96hrs
post-MI management
aspirin 75mg OM clopidogrel 75mg OD OR ticagrelor 90mg OD bisoprolol ACE inhibitor (ramipril) high dose statin (atorvastatin 80mg ON)
cardiac rehab
ECHO
define stable angina
a constriction like pain in the chest, neck, jaw and arms that is brought on by physical activity and alleviated through use of GTN
investigations in stable angina
CT coronary angiography
bloods (FBC, TFTs, troponin)
ECG
conservative management of stable angina
smoking cessation glycaemic control hypertension hyperlipidaemia weight loss alcohol intake
first line management of stable angina
aspirin
statin
sublingual GTN
beta blocker OR rate-limiting calcium channel blocker
indications of re-vascularisation in stable angina
symptoms not satisfactorily controlled with optimal medical treatment
complex 3 vessel disease
significant left main stem stenosis
