Acute Coronary Syndromes (ACS) Flashcards
What Acute Coronary Syndromes an umbrella term for?
Unstable angina, NSTEMI and STEMI
Where is the occlusion in unstable angina?
Partial occlusion of minor coronary artery
Where is the occlusion in an NSTEMI?
Either a partial occlusion of a major coronary artery or a total occlusion of a minor coronary artery
Where is the occlusion in a STEMI?
A total occlusion of a major coronary artery
Is there infarction in unstable angina?
No
Only ischaemia, no necrosis
Where is the infarction in an NSTEMI?
Subendothelial infarction
ie. the area further away from blocked coronary artery dies
Where is the infarction in a STEMI?
Transmural infarction
What does an ECG show in unstable angina?
Normal
May show some ST depression or T wave inversion
What does an ECG show in an NSTEMI?
ST depression and T wave inversion
No Q waves
What does an ECG show in a STEMI?
ST segment elevation in local leads (2+)
Q waves after some time (pathological)
When are there elevated levels of Troponins and Creatine Kinase MB?
When there is infarction
So in an NSTEMI and STEMI
What are symptoms of acute coronary syndromes?
Severe chest pain at rest
Prolonged with no relief
Sense of “impending doom”
Palpitations
How are acute coronary syndromes diagnosed?
ECG
biomarkers
CT coronary angiogram shows extent of occlusion
What is acute treatment of unstable angina or an NSTEMI?
Morphine
O2 if sats lower than 94%
Nitrates (GTN)
300mg aspirin
75mg clopidogrel
MONAC (dual antiplatelet)
Grace score and either monitor or immediate angiogram and consider PCI
What is the Grace score?
Predictor of mortality from MI in next 6 months- 3 years in patients in ACS
