Acute Coronary Syndromes Flashcards
which three conditions come under the umbrella term of ACS
unstable angina
STEMI
NSTEMI
which condition predisposes patients to developing ACS
angina
what is the pathophysiology of unstable angina
plaque rupture or fibrous cap erosion causing reduced coronary blood flow - can cause partial or complete occlusion by thrombus
what are the symptoms of unstable angina
central stabbing chest pain possibly with radiation
pain felt upon rest
dyspnoea
what investigations are carried out for unstable angina
ECG - may be normal
cardiac enzymes to rule out MI
what is the treatment for low risk patients with unstable angina
aspirin and clopidogrel
nitrates
what is the treatment for high risk patients with unstable angina
MONAC
revascularisation
what is myocardial infarction
death of myocytes due to partial or complete occlusion of blood vessel due to thrombus
what are the symptoms of MI
new onset of severe central chest pain at rest
radiating to jaw, neck, left arm
breathlessness
associated with nausea, sweating, vomiting
what investigations are carried out for MI
ECG
cardiac troponins (T and I)
exercise ECG
what are the possible findings on ECG of an NSTEMI
ST depression, T wave inversion, Q waves
how long are cardiac troponins elevated for
7 days
is myocyte death from a STEMI reversible
no
what are the ECG findings of a STEMI
ST elevation
T wave inversion
Q waves
for a diagnosis of STEMI where must the ST elevation be present
> 1mm elevation in adjacent limb leads
>2mm elevation in consecutive precordial leads
an anterior MI affects which leads
V2-6
an anterolateral MI affects which leads
V4-6, aVL
an anteroseptal MI affects which leads
V1-3
an inferior MI affects which leads
II, III, aVF
a posterior MI affects which leads
V1-2
what is the immediate treatment for a STEMI
Morphine + anti-emetic Oxygen Nitrates Aspirin chewed Clopidogrel oral gel
what class of drug are aspirin and clopidogrel
anti-platelets
what is the first line treatment for acute STEMI
PCI
what is the time frame for PCI from developing symptoms
90 minutes
after 90 minutes, what is the treatment for STEMI
thrombolysis
how does thrombolysis work
breakdown of blood clot through artificial infusion of enzyme into the blood
what is the longterm management for patient with STEMI
long term antiplatelets
advise diet high in omega 3, fruit and veg
check mental health of patient as anxiety is common
what are some complications of MI
future MI
other cardiac problems eg stroke
Dresslers Syndrome
what is dresslers syndrome
form of pericarditis that occurs 2-10 weeks post MI
autoimmune response to the MI
what are some contraindications of MI
recent surgery
stroke
severe hypertension
active peptic ulcers
