Acute Coronary Syndromes Flashcards
What is an acute coronary syndrome?
A medical emergency; when plaque buildup (atherosclerosis) in the coronary arteries can rupture leading to a clot formation leading to sudden reduced blood flow to the heart; imbalance between myocardial supply and demand and/or cardiac muscle cell death due to reduced blood flow lead to symptoms
What are risk factors for ACS?
- men >45/ women> >55 (or early hysterectomy)
- 1st-degree relative with a coronary event <55(men) or <65 (women)
- smoking
- HTN
- known coronary artery disease
- dislipidemia
- diabetes
- chronic stable angina
- lack of exercise
- excessive alcohol
What are signs/symptoms of ACS?
- chest pain lasting ≥10 minutes (often described as pressure, squeezing, or discomfort); can radiate to the arms, back, neck, jaw, or epigastric region
- dyspnea
- diaphoresis (excessive sweating)
- syncope/presyncope
- palpitations
What can precipitate ACS symptoms?
- minimal exertion
- exercise
- cold weather
- extreme emotions
- stress
- sexual intercourse
What should patients with nitroglycerin do if symptoms occur?
use 1 dose of nitroglycerin every 5 minutes for up to 3 doses; if chest pain has not improved or gotten worse since the first dose they should call 911 immediately
What medical emergencies fall under ACS?
- unstable angina
- non-ST-segment elevation myocardial infarction
- ST-segment elevation myocardial infarction
What should be done if a patient is suspected of having ACS?
- 12-lead ECG should be performed and evaluated within 10 minutes at the first site of medical contact (EMS)
- urgently transport to a facility with percutaneous coronary intervention
How are the types of ACS differentiated?
- cardiac enzymes (troponins TnI and TnT) at presentation and 3-6 hours
- ECG changes (ST elevation)
- partial or complete blockage
What are the characteristics of unstable angina?
- chest pain
- partial blockage
- transient or no ECG changes or cardiac enzymes
What are the characteristics of NSTEMI?
- chest pain
- partial blockage
- positive cardiac enzymes
- transient or no ECG changes ( ST segment depression or prominent T-wave inversion)
What are the characteristics of STEMI?
- chest pain
- positive cardiac enzymes
- ST-segment elevation (≥ 2 continuous leads; leads looking at the same area of the heart)
What are the treatment goals for ACS?
immediate relief of ischemia and preventing MI expansions and death
What is a PCI?
coronary revascularization procedure that involves inflating a small balloon inside a coronary artery to widen it and improve blood flow; usually a stent is placed to keep an artery
For what ACS is PCI appropriate?
- STEMI requires arteries be opened as soon as possible
- PCI can be considered UA or NSTEMI as an early invasive strategy
How long after arrival to the hospital does PCI need to be performed to be preferred?
90 minutes (door-to ballon time) or within 120 minutes of medical contact
