acute coronary syndromes - presentation and management Flashcards
What are the acute coronary syndromes
- Myocardial infarction
- Unstable angina
What is required to diagnose a myocardial infarction
Detection of troponin and at least one of the following:
- Ischaemia symptoms
- ECG changes
- evidence of new cardiac damage
- evidence of coronary problem on coronary angiogram
What is the presentation of a myocardial infarction
- Ischaemic sounding chest pain (heaviness or tight band like)
- radiation to neck or arm
- may have nausea, sweating and breathlessness
What investigations are key for suspected MI
ECG
What does ST elevation tell us
Complete coronary occlusion
What is a posterior MI and what is seen on ECG
An occlusion of the left circumflex artery - profound ST depression seen in the posterior lead which is the equivalent of having ST elevation of the anterior leads
How to differentiate between unstable angina and NSTEMI
If the troponin is elevated then it is a nstemi
What is the treatment for acute coronary syndromes
- Strong blood thinners such as thrombolysis
- Mechanical - balloons and stents (PCI), angioplasty
Describe what an angioplasty is
Ballon squashes plaque into the wall and then a stent is inserted into the wall so the artery wall doesn’t open again
When is thrombolysis contraindicated
- If patient has had a recent stroke
Describe treatment for STEMI
- Transfer to cath lab for primary PCI
- If can’t reach within 2 hours, give thrombolysis first
What is the anti-thrombotic drugs given for a NSTEMI
Aspirin 300mg loading dose and then 75 mg
+
Clopidogrel or ticagrelor
What should be done if there is occlusion in numerous vessels
Bypass surgery (CABG)
What does myocardial rupture cause
Cardiac tamponade - build up of fluid in the pericardium which compresses the heart
