Acute Coronary Syndromes Flashcards
Acute coronary syndromes
- Unstable angina
- NSTEMI
- STEMI
Non-modifiable risk factors for acute coronary syndrome
- increasing age
- male
- family history
- premature menopause
Modifiable risk factors for acute coronary syndrome
- obesity
- smoking
- hypertension
- hyperlipidaemia
- diabetes
Pathophysiology of acute coronary syndrome
- endothelial cell injury & inflammation
- atheromatous plaque formation
- atheromatous plaque rupture -> clotting cascade, thrombosis -> arterial occlusion
Clinical features of acute coronary syndrome
typical:
- central crushing chest pain (+/- radiating)
- anxiety, restlessness
- dyspnoea
- diaphoresis
- nausea and vomiting
- palpitations
non-typical:
- syncope/presyncope
- fatigue
- epigastric pain
Population that may not experience chest pain in acute coronary syndrome
- diabetics
- elderly
Clinical exam findings in acute coronary syndrome
appearance:
- restless, anxious
- extreme sweating
vitals:
- tachycardia
- tachypnoea
- reduced sats
- hypotension (if shocked)
Investigating acute coronary syndrome
- ECG
- Bloods - troponin
- other - cxr, echo, coronary angiography
ECG findings in unstable angina & NSTEMIs
- may be normal
- may have ST depression
- may have other abnormal findings (e.g. T wave inversion)
Differentiating unstable angina & NSTEMI
- unstable - no troponin increase
- NSTEMI - troponin increase
ECG findings STEMI
- ST elevation
- +/- new left bundle branch block
Identifying left bundle branch block on ECG
V1 = W
V6 = M
Anterior STEMI on ECG
- V1-V4
- Left anterior descending artery
Lateral STEMI on ECG
- V5, V6, AVL
- left circumflex artery
Inferior STEMI on ECG
- II, III, AVF
- right coronary artery
Management of NSTEMI
- immediate assessment (ECG, troponins)
- initial therapy (MONA-B) (aspirin, ticagrelor or clopidogrel)
- anticoagulation (fondapurinux, enoxaparin)
- risk stratification (Grace Score)
- long-term management (AAAAL)
Initial therapy for acute coronary syndrome
MONA-B
- morphine
- oxygen (if sats < 94%)
- nitrates
- antiplatelets (aspirin 300mg, ticagrelor (or clopidogrel))
- beta-blockers
Grace Score in acute coronary syndrome
- determines mortality from MI in next 6 months to 3 years
- low risk (< 3%)
- high risk (> 3%)
Low risk Grace Score in NSTEMI
- < 3%
- conservative management
High risk Grace score in NSTEMI
- > 3%
- PCI within 72 hours
Long-term management in acute coronary syndrome
- dual antiplatelets 12 months (aspirin, ticagrelor or clopidogrel)
- atorvastatin 80mg
- ACE-i or ARB
- atenolol (or other beta blocker)
- aldosterone antagonist (epleronone if HF)
- lifestyle changes
Managment of STEMI
- immediate assessment (ECG, troponins)
- reperfusion strategy (primary PCI - within 120 mins, thrombolysis - >120 mins for PCI)
- medical therapy (MONA-B)
- anticoagulation (during PCI give unfractionated heparin GPI)
- post-PCI or post-thrombolysis long-term management (AAAAL)
Antiplatelets for acute coronary syndrome
- aspirin 300mg
- ticagrelor
- clopidogrel (if on anticoagulants)
Anticoagulants used in acute coronary syndrome
- fondapurinux
- enoxaparin
- unfractionated heparin GPI (for during PCI)
Secondary prevention lifestyle changes for acute coronary syndrome
- stop smoking
- reduce alcohol consumption
- meditteranean diet
- cardiac rehab (inc. exercise regimen)
- optimise treamtent of other conditions (e.g. BP control)
