Ischaemic Heart Disease- ACS Flashcards
what does Acute Coronary Syndrome compromise?
- Unstable angina
- STEMI
- NSTEMI
symptoms?
central crushing/constricting chest pain at rest >20mins associated with:
- N&V
- sweating / clamminess
- feeling of impending doom
- SOB
- palpitations
- pain radiating down jaw /arms
what must you be wary of?
elderly / diabetics may not expereince typical symptoms : “silent MI”
may manifest as syncope, delirium, post-op oliguria /hypotension
Diagnosis?
ECG
- ST elevation/new LBBB–> STEMI
- No ST elevation
- do trop
- raised trop and/or othet features ie ST depression, pathological Q waves, T wave inversion–> NSTEMI
- trop normal & no pathological signs on ECG–> UA or other cause ie MSK related chest pain
- do trop
Ix?
- Cardiac examination
- ECG
- Bloods
- CXR
- CT coronary angio
- Echo
what bloods would you want to do?
- Troponin
- FBC
- UE
- Lipid profile
- Glucose & HbA1c
- clotting
- TFT
what are troponins and when are they raised?
- myofibrillar proteins linking actin and myosin
- raised in myocardial ischaemia
non-specific, also raised in:
- chronic renal failure
- sepsis
- myocarditis
- aortic dissection
- PE
how do you measure troponins?
require serial troponins for diagnosis of ACS
- levels rise within 3-12hrs of onset of chest pain
- do baseline + repeat at 6 and 12hrs post onset of symptoms
how long does it take for troponin levels to return to baseline?
5-14days
Rx of UA?
Initial Mx: BATMAN(O)
- Beta-blockers (unless C/I)
- Aspirin 300mg stat
- Ticagrelor 180mg stat
- Morphine
- Anti-coagulant: LMWH treatment dose
- Nitrates (GTN)
- Oxygen if sats<95%
Definitive: coronary angio +/- PCI
Mx of NSTEMI?
Initial- BATMAN(O)
Assess for risk- GRACE score (6 month risk of death or repeat MI)
<5%= low risk
5-10%= medium risk
>10%= high risk
if medium/ high risk–> considered for early PCI
if low risk–> can discharge if 12h trop -ve
in what order would you do said Mx for NSTEMI
Mx of STEMI?
Initial: BATMAN(O)
Definitive:
- primary PCI if <12h
- thrombolysis if PCI not available within 12h
in what order would you do said Mx for STEMI?
contraindications to thrombolysis? mnemonic
AGAINST
Aortic dissection
GI bleeding
Allergic reaction previously
Iatrogenic: recent surgery
Neuro: history of CVA or cerebral neoplasm
Severe HTN
Trauma incl CPR
