Acute coronary syndromes Flashcards
In an acute MI, what would be the diagnostic feature on the ECG?
ST-elevation
What other diagnostic test can be performed for MI?
Troponin T blood test
In MI, what are the features of the chest pain?
Unremitting
Usually severe but may be mild or absent
Occurs at rest
Associated with sweating, breathlessness, nausea and/or vomiting
What features lead to a higher risk of having an MI?
Higher age, diabetes, renal failure, left ventricular systolic dysfunction
What is the initial management of an MI?
Get to hospital Take 300mg aspirin Pain relief Oxygen therapy ONLY if hypoxic If ST elevation - take to primary PCI centre
What is the main cause of ACS?
Rupture of atherosclerotic plaque and consequent arterial thrombosis
What are some of the rarer causes of ACS?
Coronary vasospasm without plaque rupture
Drug abuse (amphetamines, cocaine)
Dissection of coronary artery related to defects of vessel connective tissue
Thoracic aortic dissection
What conditions other than MI may give a positive troponin result?
Gram negative sepsis PE Myocarditis Heart failure Arrythmias Cytotoxic drugs
Name 3 P2Y12 inhibitors
Clopidogrel, prasugrel, ticagrelor
What must be excluded before administering P2Y12 inhibitors?
Serious bleeding as they increase risk of bleeding
When are glycoprotein IIb/IIIa antagonists used?
In combination with aspirin and oral P2Y12 inhibitors in management of patients undergoing PCI (STEMI patients)
What do anticoagulants target?
Formation and/or activity of thrombin
Inhibit fibrin formation and platelet activation
Give an example of an anticoagulant used during PCI
Enoxaparin - low molecular weight heparin
Bivalirudin - direct thrombin inhibitor
Name the pharmacological therapies used in ACS
Initial pain relief - morphine + metoclopramide
Aspirin and P2Y12 inhibitor combination
Anticoagulants - fondaparinux or heparin
IV glycoprotein IIb/IIIa antagonists
Name some anti-anginal therapies
Beta blocker
Nitrates
Calcium antagonist
