Cardiology 3 - Acute Coronary Syndrome Flashcards
left coronary becomes what
left anterior descending
circumflex
right coronary supplies
broadly RHS of heart
right atrium
right ventricle
inferior left ventricle
posterior septum
circumflex supplies
left atrium
posterior left ventricle
left anterior descending supplies
anterior left ventricle
anterior septum
3 types of ACS
unstable angina
STEMI
NSTEMI
diagnosing ACS
- do an ECG
if ST elevation or NEW left bundle branch block = STEMI
- do troponin levels
if raised + ST depression / T wave inversion / pathological Q waves =
NSTEMI
if normal trop and non pathological ECG = unstable angina
6 symptoms of MI
nausea and vomiting central crushing chest pain + radiating jaw / arm pain impending doom short of breath palpitations
should last for >20 mins and not settle with rest
who is at risk of silent MI
diabetics
summarise ECG changes STEMI vs NSTEMI
STEMI
ST elevation, new LBBB
NSTEMI
pathological Q waves
T wave inversion
ST depression
left coronary artery region and leads
anterolateral
I
aVL
V3-6
left anterior descending region and leads
V1-4
circumflex region and leads
I, aVL, V5-6
right coronary region and leads
inferior
II, III, aVF
when to do troponins
on arrival, serial at 6 or 12 hours
5 other causes of raised troponins
chronic renal failure sepsis myocarditis aortic dissection pulmonary embolism
investigations for ACS
KEY - ECG, chest x ray, CT coronary angiogram
also - examine, FBC, UE, LFT, TFT, lipids, glucose/HbA1c
acute STEMI treatment protocol
arrived within 12 hours of symptom onset
if <2 hours since in hospital, do PCI
if longer, do thrombolysis with alteplase
likely need loading with aspirin and ticagrelor too
acute NSTEMI treatment
Beta blockers unless can't Aspirin 300mg stat Ticagrelor 180mg stat Morphine titrated Anticoag - enox 1mg/kg BD Nitrates
how to assess for PCI with NSTEMI
Grace score - risk of death or repeat MI post NSTEMI
if >5% do PCI within 4 days
6 complications of MI
death rupture of papillaries oedema arrythmia, aneurysm dressler's
dressler’s syndrome
2-3 weeks post MI
immune response
pleuritic chest pain
low fever
pericardial rub
diagnose and treat dressler’s
ECG global elevtion and T wave inversion
echo pericardial effusion
raised CRP ESR
gives NSAIDs or steroids if bad
secondary prevention post ACS
aspirin 75mg
clopidogrel for up to 1 year 300mg then 75mg
atorvastatin 80mg
ACEx ramipril to 10mg
atenolol 25mg (10mg bisoprolol instead)
aldosterone antag if hearat failure (eplerenone 50mg)
do lifestyle advice too
types of MI`
1 normal
2 induced by stressor
3 heart stops
4 procedure related
