Myocardial Infarction/Acute Coronary Syndrome Flashcards
What is it?
A blockage to a coronary artery resulting in hypoxia of the heart muscle
What is the difference between and MI and ACS?
An MI sees ST elevation on ECG plus Troponin changes, whereas ACS does not show the ST-elevation
What causes the blockage? (6)
Atherosclerotic Plaque rupture, thrombosis, inflammation, emboli, coronary spasm, vasculitis
What happens to the myocytes?
They may die and the degree of myocyte death is dependent on which area of the heart became blocked
Is it common?
Yes, there are 5 per 1000 in the UK
Who does it affect?
More common in middle age males
Risk Factors (11)
Age, Male, Family history, Smoking, Hypertension, Diabetes, Hyperlipidaemia, Obesity, Alcohol, Cocaine, Stress
Symptoms (7)
Central chest pain (must be for more than 20 minutes), nausea, sweating, dyspnoea, palpitations, vomiting, syncope
Signs (5)
Grey Pallor, distress, Tachycardia, Hypotension, Pansystolic murmur
How might a diabetic patient present?
Sweating, Nausea, Syncope-They can have silent MI’s due to Neuropathy from their diabetes so ALWAYS do an ECG in a patient with all the symptoms but no chest pain
Investigations
ECG, CXR, Cardiac Markers (troponin, creatine kinase-MB), FBC, U&E
What might an ECG show? (2)
ST-elevation or depression, left bundle branch block
What would Troponins show?
A troponin for baseline and then a Troponin 12 hours later would show a big increase
Differentials (3)
Angina, Oesophageal Reflux, Pericarditis
First Line Treatment (5)
MONAC M-morphine O-oxygen N-Nitrates (GTN or Isosorbide Mononitrate) A-Aspirin C-Clopidogrel
