Acute Coronary Syndromes Flashcards
What three conditions make up ACS?
Unstable Angina, MI, Sudden Cardiac Death
What are two types of MI, what is the difference?
STEMI- ST elevated MI- Vbad
NSTEMI- non- ST elevated MI- often less severe.
What is the pathophysiology?
Plaque rupture and local thrombosis.
What causes plaques to rupture?
- Inflammation
- Flow changes
- Change in the make up of blood
- Stress on the endothelial wall.
Risk Factors
-Age, Gender, Previous Angina/MI, Genes, Smoking, Hyperlipidaemia, Hypercholesterolaemia, Hypertension, Diabetes.
What to look for in an ECG?
Transient ST elevation T wave inversion ST segment depression -UAP changes will be temporary -NSTEMI- changes persist at rest
What groups may experience atypical symptoms?
Women, Diabetics, Elderly
Name atypical symptoms
Breathlessness (heart failure) Nausea & Vomiting (autonomic symptoms) Epigastric Pain (recent onset indigestion)
What biomarker may be evident?
Cardiac Troponin
- Will be present in the blood after damage to myocardial cells
- Not specific to ACS - just shows damage.
Treatment of UAP & NSTEMI
ABCDE- ensure stable MONA Dual Antiplatelet therapy for 1 year Anti-thrombotic therapy- Heparin/ Fondaparinux B blockers Statins ACE- if left ventricular dysfunction
What does MONA stand for?
Morphine
Oxygen
Nitrates (GTN)
Aspirin - 300mg
Describe Dual Anti-platelet therapy
Aspirin + Clopidogrel
Describe anti-thrombotic therapy
Low molecular weight heparin
Fondaparinux
What is the target heart rate?
50-60 bpm
Surgical intervention?
Coronary Revascularisation
- PCI
- CABG
STEMI
More complete/ complete occlusion of Artery
Leads to INFARCTION
What key structures could be affected?
- Papillary Muscles
- AV node
Aim in treatment of STEMI?
Remove occlusion and restore circulation to Ventricles
How to remove an occlusion?
- Primary PCI
- Fibrinolysis
When to do primary PCI
- door to balloon <90 mins
- >3hrs symptom onset
When to do Fibrinolysis?
- door to balloon = 90 mins
- <3 hrs symptom onset
- Can be done Pre-hospital in remote situations.
- Risk of bleeding and haemorrhage.
Prevention of STEMI
ASA + clopidogrel
Beta Blocker
Statins (lower LDL <3.2mmol/l)
ACE Inhibitor (in LV dysfunction)
What two things may determine survival of MI?
Age & Ejection Fraction
-measure ejection fraction on ECHO
Describe SCD
Atherothrombus leads to Acute Myocardial Ischaemia leads to Ventricular Arrhythmia (VF)
What can VF lead to?
Asystole- v v bad
Treatment for VF?
EARLY Defib- only treatment
