Acute coronary syndromes (ACS)

Question 1

ACS includes?

Answer 1

1. ST-segment elevation myocardial infarction (STEMI)
2. non-ST-segment elevation ACS (NSTEACS), which comprise;

• unstable angina
• non-STEMI

Question 2

Pain of myocardial ischaemia: typical site

Answer 2

The typical retrosternal pain or pain situated across the chest anteriorly should be regarded as cardiac until proven otherwise.

The wide variation of sites of pain should always be kept in mind e.g.

• jaw, neck
• inside of arms
• epigastrium interscapular

Pain is referred into the left arm 20 times more commonly than into the right arm.

The quality of the pain is usually typical.

The patient often uses the clenched fist sign to illustrate a sense of constriction.

Question 3

Serum markers v ECG changes

Answer 3

Creatinine kinase / Troponin/ ECG

Unstable angina

• low risk: normal / non-detectable / normal
• high risk: normal / detectable/ ST depression

Myocardial infarction

• NSTEMI: elevated / detectable / ST depression, no Q wave
• STEMI: elevated / detectable / ± Q wave