Acute Coronary Syndromes Flashcards
name what happens when there is spontaneous plaque rupture and local thrombosis with degrees of occlusion
acute coronary syndromes
give four examples of acute coronary syndrome
> unstable angina
non-ST elevation myocardial infarction
ST elevation myocardial infarction
sudden cardiac death
describe the character of the patients chest pain
> site: retrosternal > character: tight band > radiation: neck, jaw, down the arms > aggravating: exertion, motional stress > relieving factors: incomplete improvement with GTN or physical rest
name some modifiable risk factors associated with ACS
> smoking > diabetes mellitus > hyperlipidaemia > hypertension > lifestyle
what would the typical history for unstable angina/ NSTEMI be?
progressive angina with increasing frequency and severity
NSTEMI there will often be myocardial ischaemic symptoms occurring during rest
what would you expect to see on the examination for an unstable angina/NSTEMI?
look unwell or completely fine and there are often no specific features to be found
what investigations should you carry out for an unstable angina or STEMI?
ECG
biomarkers
what would you expect to see on an ECG of an unstable angina or NSTEMI?
they may be normal but there is commonly a st-segment depression, transient st-segment elevation or a t wave inversion.
in unstable anginas the changes resolve after pain but in NSTEMI they tend to persist
what is used as a biomarker in acute coronary syndromes?
cardiac troponin
what would an elevated cTn suggest?
a high risk of adverse events
when are cTn levels elevated?
when there is compromise to myocyte intergrity
what is the MONA treatment?
Morphine
Oxygen
Nitro-glycerine
Aspirin
what anti-platelet therapy should all acute coronary syndrome patients receive?
both aspirin and ADP receptors blocker:
> clopidogrel
> prasugrel
> ticagrelor
name the anti-thrombotic therapy that acute coronary syndrome patients can be put on?
> intravenous in-fractured heparin
> low molecular weight heparin
what are the contraindications for using beta-blockers to treat acute coronary syndrome?
> asthma
acute left ventricular dysfunction
impaired atrioventricular nodal conduction
when are angiotensin converting enzyme inhibitors given in acute coronary syndromes?
if there is left ventricular dysfunction
what non-medical therapy can be given to treat acute coronary syndrome?
coronary angiography and revascularisation by PCI or CABG
what can plaque rupture lead to?
more complete thrombotic occlusion or coronary lumen and infarction of distal myocardium
how can you increase the amount of myocardium that can be salvaged after a ST-elevated myocardial infarction?
by dissolving/removing the occlusive thrombus quickly
what has been proven to be a superior treatment of ST-elevated myocardial infarction and why?
primary PCI (over fibrinolytic therapy) for al cause, cardiac mortality, recurrent MI and reduced risk of haemorrhagic stroke
how quickly should you aim to begin fibrinolysis for a STEMI?
> 90 minutes from the patient calling for help
> 30 mins of hospital arrival
how can the call to needle time of fibrinolysis be reduced?
pre-hospital fibrinolysis
what can increase the risk of intra-cranial haemorrhage from fibrinolytic therapy?
> over 75 years > female > previous stroke > low body weight > SBP >160mmHg > chronic kidney disease
in what scenario is primary PCI the best course of treatment for a STEMI?
> door to balloon time = less than 90 mins > less than three hr symptom onset > cardiac shock > high bleeding risk > uncertain diagnosis
