Chapter 4: Cardiac Causes of Cardiac Arrest Flashcards
How can acute coronary syndrome be split up?
STEMI
Non ST Elevated acute coronary syndromes:
- NSTEMI
- Unstable angina
What can be used to determine between STEMI and NSTEMI?
ST elevation or new LBBB = STEMI
Other ECG changes = NSTEMI/Unstable angina
How do you differentiate between unstable angina and NSTEMI?
Troponin release
What may indicate that a non-ST elevated ACS may be high risk?
- ST depression
- Dynamic ECG changes (different from baseline)
- ** Unstable rhythm**
- Unstable haemodynamics
- Diabetes
- High GRACE score
Which groups of people may present with ACS less typically?
Females
Elderly
Diabetics
What are some atypical symptoms of ACS?
- Indigestion type pain
- Pain radiate to throat, into one or both arms, into back or upper abdomen
- ASx
What ECG changes can an NSTEMI/unstable angina show?
Normal
ST Depression
Non specific abnormalities - t wave inversion
When is risk of progression from NSTEMI to full occlusion highest?
First few hours, days and months
What is there a substantial risk of in the acute phase of a STEMI?
- VF
- VT
- Sudden death
What ECG changes may be seen in a STEMI?
- ST elevation
- New LBBB
- Pathological q waves
- T wave inversion
- Hyperacute t waves (v early)
How quickly do you aim to give PCI in a STEMI? What should you do if this can not be achieved?
Within 120 minutes of onset of chest pain
Fibrinolytic therapy
Which leads indicate where an infarct may be?
Anterior - V1-4 = LAD
Inferior - II, III, AVF = RCA
Lateral - I, AVL, V5-6 = Left Circumflex
Posterior - Reciprocal changes to anterior (ST Depression in V1-4) = RCA
What is important to know about posterior MI’s?
Must confirm with posterior leads
Risk of bradycardia as SAN may be affected
What other conditions can cause acute ST depression or t wave inversion?
- Subarachnoid haemorrhage
- Traumatic brain injury
- Major PE - t wave inversion
Why is echocardiography useful in acute ACS?
- Confirm LV systolic Fx - related to prognosis
- Can prompt diagnoses of cardiomyopathy, valve disease, pericardial disease, aortic dissection and PE
- Can confirm RV dilatation & impairment