Myocardial infarction/acute coronary syndrome Flashcards
What is the definition of an MI/acute coronary syndrome?
Acute coronary syndrome: a range of heart disorders e.g. MI, unstable angina all caused by the same underlying problem which is a reduction of blood flow to part of the heart
Either with ST-segmented elevation or without ST-segment elevation
What is the epidemiology of MI/acute coronary syndrome?
Around 73000 deaths each year in the UK
What is the pathology of MI/acute coronary syndrome?
- Mostly due to atherosclerotic plaques in the coronary arteries
- Plaque breaks up inside the artery
- = blood clot forms on the plaque surface and blocks the blood flow through the coronary artery
- Lack of oxygen to the myocardium – sub-endocardial myocardium is initially affected
- Myocardial necrosis
What are the risk factors/aetiology for MI/acute coronary syndrome?
- Family history/genetics
- Age – risk ↑ with age
- Male
- Asian/African descent
- Hyperlipidaemia – inc. familial hypercholesterolaemia
- Smoking
- Alcohol
- Angina
- Hypertension
- Diabetes
- ↓ exercise
- Obesity
- Gout
- Soft water
- Drugs: OCP, nucleoside analogues, COX-2 inhibitors
What are the signs and symptoms of MI/acute coronary syndrome?
- Acute central crushing chest pain lasting >20 mins
- Pain may radiate to neck/jaw/left arm
- Diabetes may not feel pain due to neuropathy
- Pain doesn’t respond to GTN spary
- Nausea/vomiting
- Sweatiness
- Syncope
- Dyspnoea
- Thready pulse with palpitations/tachycardic/bradycardic
- Hypertension
- 4th heart sound
- Signs of heart failure - ↑ JVP, 3rd heart sound, basal crepitation
- Pansystoilic murmur
- Pericardial friction rub
- Peripheral oedema
What diseases present similarly to MI/acute coronary syndrome?
- Angina
- Pericarditis
- Pancreatitis
- Myocarditis
- Aortic dissection
- PE
- Oesophageal reflux/spasm
- Peptic ulcer
What investigations would be carried out for suspected MI/acute coronary syndrome?
- ECG
- Bloods: FCB, U&E, glucose, lipids
- Cardiac biomarkers: troponin (T and I) creatine kinase (CK-MB)
How does having a MI/acute coronary syndrome affect everyday life/work?
- Patient can only return to work 2 months after – unless airline pilot, air traffic controller, divers, drivers
- Avoid travel for 2 months
- Sexual intercourse is best avoided for 1 month
What are the surgical treatments for MI/acute coronary syndrome?
•Angioplasty/angiography
What are the pharmacological treatments for MI/acute coronary syndrome?
- Aspirin 300mg
- GTN spray
- Morphine
- Oxygen
- Thrombolysis
- Beta blocker – discharge medication
- ACE inhibitor – discharge medication
- Clopidogrel/Aspirin 75mg – discharge medication
- Statin – discharge medication
What are the non pharmacological treatments for MI/acute coronary syndrome?
- Lifestyle modifications - ↓ fat, sugar and ↑ exercise
- Smoking cessation
- Risk: GRACE SCORE = 6 month mortality for patients with acute coronary syndrome
