Acute Coronary Syndromes Flashcards
What are acute coronary syndromes?
A new onset of a collection of symptoms, related to a problem with the coronary arteries.
Causes myocardial ischaemia.
If prolonged, can cause an MI.
What are the differences between ACS and stable angina?
Caused by an ‘unstable’ coronary lesion.
Unpredictable symptoms, may occur at rest.
Includes MI and unstable angina.
How do you diagnose MI?
Detection of cardiac cell death (positive cardiac biomarkers - myoglobin, troponin).
And symptoms of ischaemia, new ECG changes, evidence of a problem on coronary angiogram or autopsy, or new cardiac damage.
What are the non-coronary causes of troponin rise?
Arrhythmia.
Pulmonary embolism.
Cardiac contusion.
Sepsis.
Anaemia.
What are the types of MI?
I - spontaneous, associated with ischaemia, due to a plaque rupture/fissure.
II - due to a supply and demand mismatch from ischaemia (not due to thrombosis).
III - sudden cardiac death and arrest. ST elevation.
IVa - associated with PCI.
IVb - associated with stent thrombosis.
V - associated with CABG.
What are the symptoms of ACS?
Ischaemic-sounding chest pain - radiates to the neck and arm, more of a discomfort or weight.
Associated with nausea, sweating and SOB.
What are the risk factors of ACS?
Male.
Age.
Known heart disease.
High BP or cholesterol.
Diabetes.
Smoking.
Family Hx of premature heart disease.
How should you examine ACS?
May look very unwell (STEMI).
May look completely fine.
Check HR and BP in both arms.
Auscultate for murmurs and crackles.
How should you interpret an ECG in ACS?
Complete coronary occlusion - initial ST elevation, with Q waves later.
Partial coronary occlusion - initial ST depression or T wave inversion or normal.
Repeat if there are any changes, for STEMIs.
Consider posterior leads.
What can be identified from ST elevation?
Anterolateral - V2-V6, likely acute (LAD).
Inferior - V2/V3/aVF, likely acute (RCA).
Occlusion of the LCx may not be seen via ST elevation. Easily missed if no posterior leads.
Opposite changes in V1 and V2.
How are acute coronary syndromes differentiated?
Typical angina for >20min.
STEMI = ST elevation.
NSTEMI = no ST elevation, high troponin.
Unstable angina = no ST elevation or troponin.
What is reperfusion therapy?
Mechanical - balloons, stents, PCI.
Pharmacological - thrombolysis (strong blood thinners, Metalyse; given before transfer to cardiac centre with a cath lab).
What are important details with thrombolysis?
Can cause bleeding.
Do not give if recent stroke or previous intracranial bleed.
Caution if recent surgery, on warfarin, or severe hypertension.
Useful if given early.
>2hrs away from a cath lab (otherwise, go to a cath lab for a PCI).
What is the management of ACS?
Hospital admission - attach to a cardiac monitor for the first 24-48hrs, listen for new murmurs and signs of heart failure every day, and start secondary prevention drugs, ECG.
IV and O2 (if low).
What is the treatment of ACS?
GTN - vasodilation (useless if complete occlusion).
Opiates - relieves anxiety.
Anti-thrombotic drugs - aspirin and clopidogrel, ticagrelor, or prasugrel.
Anti-coagulant drugs - heparin, fondaparinux.
BBs, statins, ACEis.
