Acute Coronary Syndromes USE CARDIO DECK - SOME STUFF HERE NEEDS MOVING ACROSS Flashcards
What counts as ACS?
Unstable angina
STEMI
NSTEMI
What cardiac enzymes are used to assess myocardial damage?
Troponin T (used at NGH) high sensitivity trop T - because is high sensitivity, can be done within 6hrs (unlike traditional assays which should be done within 12hrs)
CK = non specific
CK-MB = slightly more specific but still not cardio selective
What is required for a diagnosis of MI?
Clinical picture
ECG changes
Raised cardiac enzymes
What further tests are available after ECGs and bloods in MI?
CT coronary angiography
Myoview = cardiac MRI
What pain relief is given in MI?
Morphine IV
GTN (for partial reversal of pathology) - spray, buccal, IV
What procedures may be indicated in MI?
Primary PCI = percutaenous coronary intervention, angioplasty using a balloon catheter to relieve obstruction ± put a stent in) or
CABG =coronary artery bypass grafting, using vessels from elsewhere on body to bypass stenotic arteries for revascularisation
When should PCI be given?
Adults with acute ST-segment-elevation myocardial infarction (STEMI) who present within 12 hours of onset of symptoms have primary percutaneous coronary intervention (PCI), as the preferred coronary reperfusion strategy, as soon as possible but within 120 minutes of the time when fibrinolysis could have been given
Given to reduce death of cardiac myocytes secondary to prolonged ischemia
What can be given if PCI is unavailable? What are the ECG criteria for this?
Fibrinolysis - drug e.g. alteplase, streptokinase, reteplase
When treating people with fibrinolysis, give an antithrombin at the same time.
?? ST segment elevation or new LBBB?
What are some contraindications to thrombolysis?
Acute pancreatitis; aneurysm; aortic dissection; arteriovenous malformation; bacterial endocarditis; bleeding diatheses; coagulation defects; coma; heavy vaginal bleeding; history of cerebrovascular disease (especially recent events or with any residual disability); neoplasm with risk of haemorrhage; oesophageal varices; pericarditis; recent gastro-intestinal ulceration; recent haemorrhage; recent surgery (including dental extraction); recent trauma; severe hypertension
hypersensitivity to gentamycin - due to cross over in manufacturing
What other drugs can be given as well as thrombolysis and PCI?
Bivalirudin in combination with aspirin and clopidogrel is recommended for the treatment of adults with STEMI undergoing primary PCI
What follow up treatment is required?
Ticagrelor in combination with low-dose aspirin is recommended for up to 12 months as a treatment option in people with STEMI
What ECG things are important?
NEEDS MORE:
Anterior MI = V1-4 (left anterior descending)
Lateral MI = 1, aVL, V5-6 (left coronary or diagonal branch of LAD)
Inferior MI = 1, 2, aVF (right coronary or left circumflex)
ST depression in anterior leads = posterior MI vs ischemia - need to do a posterior ecg - will show ST elevation (?)
