Acute Coronary Syndromes (ACS) Flashcards
What are the 3 clinical subtypes?
Unstable angina (UA)
Non-ST segment elevation myocardial infarction (NSTEMI)
ST segment elevation myocardial infarction (STEMI)
What is it due to?
Sub-total = UA + NSTEMI
OR Total coronary artery occlusion (STEMI)
Complication of atherosclerosis
What is unstable angina characterised by?
Acceleration in frequency/severity of chest pain
New onset pain
Pain that occurs at rest
NO enzymatic evidence
Presence of an active pro-thrombotic surface at the site of plaque rupture
What is NSTEMI characterised by?
Unstable plaque rupture + thrombosis
Positive enzymatic evidence
Presence of persistent pro-thrombotic surface at site of plaque rupture
What is STEMI characterised by?
Unstable plaque rupture + thrombosis
Positive enzymatic evidence
Ischaemia-induced electrical instability
What is myocardial infarction (MI)?
Necrosis of myocardial tissue within 20-40 minutes of occlusion
Significant necrosis at 2-3 hours
What are the clinical features of pain of MI?
Acute central chest pain
Lasting >20 minutes
Often associated with nausea, sweatiness, dyspnoea, palpitations
What are the ECG changes for MI?
T wave inversion
ST segment elevation
Q wave development
What are the enzymatic changes for MI?
Troponin enzymes (T + I) released by heart tissues
= sign of necrosis
Why troponin T?
Can be released from cardiac muscle or skeletal muscle
Why troponin I?
Extremely specific for cardiac muscle = ideal marker for cardiac injury
What are the emerging biomarkers for MI?
Heart fatty acid-binding protein
B-type natriuretic peptide
Ischaemia-modified albumin
Co-peptin
What is the ECG change for STEMI?
ST elevation
What is the ECG change for NSTEMI?
ST depression
T inversion
What is the diagnostic criteria for MI?
Rise/fall in serum cardiac biomarkers
PLUS at least one…
Symptoms of ischaemia
ECG changes: new ST / T wave changes
Development of Q waves
Loss of myocardium on imaging
What are the non-modifiable risk factors of MI?
Age
Male gender
Family history of IHD
What are the modifiable risk factors of MI?
Smoking
Hypertension
DM
Hyperlipidaemia
Obesity
Sedentary lifestyle
What are the clinical management steps for MI?
Relieve pain
Recognise
Treat
Prevent complications
What is myocardial salvage?
Reduce myocardial O demand
Restore myocardial blood supply
How do you reduce myocardial O demand?
Beta blockers
Nitrates
How do you restore myocardial blood supply?
Reperfusion
What is improve survival?
Secondary prevention
Combo pharmacological + non-pharmacological
What is the pharmacological approach for improved survival?
Statin
ACE
Dual antiplatelet
Beta blocker
GTN
What is the non-pharmacological approach for improved survival?
Cardiac rehabilitation
What are the lifestyle changes post MI?
Changing diet
Alcohol consumption
Regular PA
Smoking cessation
Weight management
Sexual activity
Psychological and social support
