Acute Coronary Syndromes Flashcards
Presentation, Management and Therapy
What is an Acute Coronary Syndrome?
Characterised as any sudden cardiac event suspected or proven to be related with the coronary arteries. Problems arise due to myocardial ischaemia which is a reduction in blood supply to the heart muscle (for example in CHD)
What is a myocardial infarction?
Myocardial Infarction (MI) implies cell death due to ischaemia.
Major MI - Complete coronary artery occlusion
Minor MI - due to a partial coronary artery occlusion
Describe ECG of a complete coronary occlusion
Initial ECG - ST elevation
ECG at 3 days - Q waves
How is MI diagnosed?
Positive cardiac biomarkers
AND one of:
symptoms of ischaemia
new ECG changes
evidence of coronary problem on coronary angiogram or autopsy
evidence of new cardiac damage on another test
Name 3 types of acute coronary syndrome associated with rupture of plaque inside the coronary arteries
Non-ST segment elevation myocardial infarction (NSTEMI)
ST segment elevation myocardial infarction (STEMI)
Unstable angina
Name some cardiac biomarkers
Myoglobin
Troponin
CK-MB
Name some non-cardiac causes of troponin rise that show troponin on it’s own doesn’t mean MI
Pulmonary embolism
Sepsis
Renal failure
Sub-arachnoid haemorrhage
Ways other than coronary atherosclerosis that an MI can arise
Coronary vasospasm - cocaine, triptans (anti-migrain medication), 5-FU
Coronary dissection
Embolism of material down coronary artery e.g thrombus from mechanical valve, tumour , AF
Inflamation of coronary arteries (vasculitis)
Radiotherapy to chest can cause fibrosis and stenosis of coronary arteries
The areas of Myocardial Infarction and corresponding coronary arteries
Inferior MI - Right Coronary A.
Anterior MI - Left Anterior Descending A.
Lateral MI - Circumflex Coronary A.
Name some secondary prevention of ACS and AMI meant to minimise risk factors.
Smoking cessation
Identify and treat DM, hyperlipidaemia and hypertension
Healthier diet filled with vegetables, oily fish, fruit and fibre
Encourage exercise
Ensure stable mental health
Name the cardioprotective medications that should be given in ACS management
Antiplatelets e.g. aspirin (75mg OD) and a second antiplatelet agent e.g. Clopidogrel for at least 12 months to decrease vascular events. consider adding a PPI
Anticoagulates until discharge
B-Blockade continued indefinately in those without contraindications
ACE inhibs should be commenced irrespective of left ventricular systolic function
High dose statin e.g atorvastatin 80mg
Immediate treatment in patients with suspected acute coronary syndrome?
Admitted to hospital urgently and treated immediately with: Oxygen Aspirin 300mg Clopidogrel 300mg Low-molecular weight heparin Beta Blockers
How would ongoing chest pain be treated?
May require iv opiates and oral, sublingual or iv nitrates
When should coronary angiography be considered?
In patients presenting with unstable angina, NSTEMI OR STEMI
When might a ‘silent’ ACS without chest pain be seen?
In the elderly or in diabetic patients
