Acute coronary syndromes Flashcards
What are the different acute coronary syndromes?
Unstable angina
STEMI
NSTEMI
What is present on an initial ECG and an ECG at 3 days for complete coronary occlusion?
ST elevation then Q waves
- Hyperacute T waves
What is present on an initial ECG and an ECG at 3 days for partial coronary occlusion?
No ST elevation then No Q waves
- ST depression
- T wave inversion
- May be normal
What is the main example of chronic ischaemic heart disease?
Stable angina
How do you diagnose MI?
Detection of cardiac cell death
- Positive cardiac biomarkers (TROPONIN)
- Symptoms of ischaemia
- New ECG changes
- Evidence of coronary problem on coronary angiogram or autopsy
- Evidence of new cardiac damage on another test
What are non-cardiac causes of troponin rise?
- Pulmonary embolism
- Sepsis
- Renal failure
- Sub-arachnoid haemorrhage
What are the different types of MIs?
Type 1 Type 2 Type 3 Type 4a Type 4b Type 5
Which arteries correspond with inferior, anterior and lateral MI?
Right coronary artery = Inferior MI
Left anterior descending coronary artery = Anterior MI
Circumflex coronary artery = Lateral MI
What are common causes of cardiac chest pain?
Coronary artery disease Aortic valvular disease Pulmonary hypertension Mitral valve prolapse Pericarditis Idiopathic hypertrophic subaortic stenosis
What are cardiac risk factors?
Male Age Known heart disease Hypertension High cholesterol Diabetes Smoker Family history of premature heart disease
What are treatments for ACS?
Reperfusion therapy: Mechanical, primary PCI or pharmacological
- Angioplasty
- Thrombolysis (tenecteplase)
What are investigations to carry out?
- Serial ECGs: consider posterior leads
- Blood tests: check not anaemic, check kidney function, cholesterol, thyroid
If patient has more chest pain what can you give them?
Glycerol trinitrate (GTN)
- Vasodilator, opens up coronary arteries
- Can give sub-lingual or as intravenous infusion
Opiates (e.g. morphine)
- Helps relieve anxiety too
- Also helps venodilate
Antiplatelet drugs used
Aspirin
Clopidogrel
Ticagrelor
Anti-thrombotic drugs used
Heparin
LMWH
Fondaparinux
Other pharmacology used
Beta blockers
Statins
ACE inhibitors
What are risks of coronary angiography/angioplasty/stenting?
Bleeding Blood vessel damage Myocardial infarction Coronary perforation Stroke Dye can affect kidneys
What are complications following an MI?
Arrhythmia Mechanical: cardiogenic shock myocardial rupture Valve dysfunction due to papillary muscle dysfunction/rupture Acute ventricular defect
What should you do pre-discharge for ACS?
Check on correct medications
Address risk factors
Cardiac rehabilitation
Follow-up plans
