Acute coronary syndromes Flashcards
What is an acute coronary syndrome
A sudden collection of symptoms suspected or proven to be related to a problem with the coronary arteries
Name the acute coronary syndromes
Unstable Angina
ST elevated MI
Non-ST elevated MI
Is stable angina an acute coronary syndrome
No
What is a Myocardial infarction
Cardiac cell death due to prolonged ischaemia
What is a cardiac arrest
Abnormal hearth rhythm thats not compatible with life
Give some examples of cardiac arrest
Atril fibrillation
Ventricular fibrillation
Tachycardia
Asystole
What is unstable angina
When patients suffer discomfort at rest OR if the symptoms are worsening.
When an atheromatous plaque gets disrupted and platelets start aggregating.
What is a NSTEMI
Partial coronary occlusion
No ST elevation (can be depression)
Inverted T waves
Pathological Q waves
What happens to Q waves in an NSTEMI
No Q waves after 3 days
What is a STEMI
Complete coronary occlusion
ST elevation
What happens to Q waves in an STEMI
Q waves after 3 days
What are the presenting symptoms of acute coronary syndromes
Chest pain
Nausea, sweating, breathlessness
What kind of chest pain do patients get with acute coronary syndromes.
Severe but not agony
Can radiate down left arm
What can happen with diabetics getting an acute coronary syndrome
it can be silent
What are risk factors for acute coronary syndrome
Male Age High BP High cholesterol Diabetes Smoking Family Hx Known heart disease
What is difficult about examining myocardial infarction patients
They may look very well or completely fine
What should be looked for in a clinical exam in suspected MI
Heart rate Blood pressure (in both arms) Murmurs Crackles in chest Raised JVP
What investigations should be done in suspected MI
ECG Troponin Hb kidney function cholesterol
What is a feature on an ECG in a STEMI
ST elevation
What is a STEMI
complete occlusion
What is a feature on an ECG in a N-STEMI
ST depression
T wave inversion
Why is an ECG a useful tool when investigating MI
Can differentiate between a STEMI and NSTEMI
Helps locate where the problem is ie inferior, anterior, posterior
How do investigate a posterior ECG
Put leads on back of chest
What is troponin
a cardiac biomarker
What sub groups of troponin can rise in a MI
Troponin I
Troponin T
What is diagnosed if ST is not elevated and no troponin is detected.
Unstable angina
What can cause an increase in troponin
Arrythmia Pulmonary embolism Trauma Sepsis Renal failure
What is primary aim of STEMI treatment
Need to get coronary artery open ASAP
What general methods can be used to open coronary artery in STEMI treatment
Mechanically
Pharmacologically
What mechanical method is used in STEMI treatment
Angioplasty
What is angioplasty
Using a ballon stent to mechanically open a vessel
What pharmacological methods should be used in treatment of a STEMI (x9)
Thrombolysis (Tenecteplase) Morphine GTN Antiplatelet drugs Anti Coagulant Statin Beta Blocker ACE inhibitors Oxygen
What are contraindications to thrombolysis in STEMI
Dont give if recent stroke (3 months) Ever had an intracranial bleed. Intra cranial neoplasm Suspected aortic dissection Severe hypertension Head trauma Caution if on warfarin
Why is morphine used in STEMI treatment
Anxiety and venodilation
Why is GTN used in STEMI treatment
Vasodilation
What is dual anti-platelet therapy
Aspirin and Clopidogrel
What is initial loading dose for aspirin and clopidogrel
300mg
Name 2 anticoagulant drugs
Heparin
Fondaparinux
What does statin do
Lowers cholesterol
What do Beta blockers do
Block sympathetic activation of heart
ie. REDUCES WORK ON HEART
What do ACE inhibitors do?
Blocks vasoconstriction and aldosterone secretion
HELPS HEART RECOVER
Why is NSTEMI treatment more complicated
There may not be such an obvious coronary presentation
What drugs can be used in NSTEMI treatment
Aspirin Clopidogrel Fondaparinux/Heparin Statins B blockers Nitrates
How does aspirin work
Its a potent inhibitor of platelet thromboxane A2 production
What does thromboxane A2 do
stimulate platelet aggregation and vasoconstriction
What can be done to increase myocardial oxygen supply
Thrombolysis
Coronary vasodilation
What can be done to decrease myocardial oxygen demand
Decrease heart rate
decrease blood pressure
decrease pre load or myocardial contractility
In what time scale does thrombolyis need to be administered
Within 2 hours
How does thrombolysis work
The drug converts plasminogen to the natural fibronyltic agent plasmin. Plasmin then breaks down fibrinogen and fibrin
