Acute Coronary syndromes presentation + management Flashcards
What is an acute coronary syndrome
Symptoms relating to problem with coronary arteries
ACS causses myocardial ischaemia
What is the differernce between stable angina and ACS
Stable angina:
Cased by stable coronary lesion
Predictable symptoms
Symptoms relieved by rest
ACS:
Unstable coonary lesion
Unpredicactale
May occur at rest
Includes MI & unstable angina
What does the history involve in someone with ACS
Ischaemic sounding chest pain
May radiate to neck/arm
Deny pain- call it discomfort
Nausea, sweating, breathlessness
What can an examination of someone with ACS look like
May look unwell if have STEMI
Or look fine
Ensure to check:
HR, BP
Listen for murmers, crackles in chest
What does complete coronary occlusion look like on the ECG
Initial ECG- ST elevation
ECG at 3 days- Q waves
WHat does partial coronary occlusion look like on ECG
Initial ECG:
ST depression
T wave inversion
or Normal
ECG at 3 days:
No Q waves
How can anterolateral ST elevation form
Acute MI due to blocked LAD
What can an Inferior ST elevation be due to
Acute MI due to blocked RCA
What will be seen in the ECG in posterior MI
Blocked LCx
Opposite changes in leads V1-V2
Summary of how to spot difference between Stable angina and ACS
WHat therapy can open blocked artery
Reperfusion therapy
Mechanical- Using Primary PCI
Pharmacological- strong blood thinner
What treatment can be given if not next to an ambulance
Thrombolysis
Strong blood thinning medication
What are the risks of thrombolysis
Bleeding
Dont give if had recent stroke
Or if had surgery and on warfarin
What is the better option Cath lab or Thrombolysis to treat STEMI
Thrombolysis only works if given early
Cath lab generally better unless too far away
What are the mangement options for ACS
Admit to hospital
ECG
Attach to a cardiac monitor
Gain iv access
Give O2 only if levels low