Cardio - ACS Flashcards
Acute Coronary Syndrome - what is it?
Umbrella term given to cover acute presentations of ischaemic heart disease: 1. STEMI 2. NSTEMI 3. Unstable angina
Acute Coronary Syndrome - what are the symptoms and signs?
CHEST PAIN - central/left sided Radiates to left arm and jaw Pain radiating to jaw Palpitations Sweating Dyspnoea Nausea + vomiting Pale and clammy
Acute Coronary Syndrome - investigations?
ECG Cardiac markers - troponin Bloods - FBC, U&Es
Acute Coronary Syndrome - what is the treatment for high risk STEMI?
M - Morphine O - Oxygen N - Ntrates A - Aspirin T - Ticagrelor (or Clopidogrel) Only give O2 if Oxygen sats <94%
Acute Coronary Syndrome - what is commonly given for pain relief?
Morphine GTN
Acute Coronary Syndrome - what is done and given for treatment in an NSTEMI?
Assess risk using GRACE score If patient is deemed high risk - angiography within 72 hours, and administer GPIIa/IIIb antagonist infusion If patient is deemed low risk - angiography at later date, and repeat troponin
Acute Coronary Syndrome - what are GPIIa/IIIb antagonists?
GPIIb/IIIa antagonists inhibit platelet aggregation
Acute Coronary Syndrome - what is the secondary prevention (lifelong management)?
Patients who’ve had an ACS require lifelong drugs - help lower risk of further event. Standard therapy is the following as a minimum: 1. Beta blockers 2. Aspirin 3. ACE inhibitors 4. Statin
Acute Coronary Syndrome - making a diagnosis
Patient presents with ACS symptoms 1. ECG - ST elevation or new LBBB, then STEMI 2. If no ST elevation, do troponin 3. Raised troponin and/or other ECG changes such as: ST depression T wave inversion Pathological Q waves DIAGNOSIS IS NSTEMI 4. Troponin levels normal and ECG no changes - unstable angina, or another cause e.g. MSK pain
Acute Coronary Syndrome - which patients might suffer a ‘Silent MI’?
Diabetic patients Do not experience typical chest pain
Acute Coronary Syndrome - which artery affects which heart area, and what ECG leads does it show up in?
Left Coronary Artery Anterolateral I,aVL, V3-6 LAD Anterior V1-4 Circumflex Lateral I, aVL, V5-6 Right Coronary Inferior II, III, aVF Artery