Non-ST segment elevation ACS, E, manifestation, D

Question 1

What is Acute coronary syndrome ?

Answer 1

• a set of symptoms caused by a decreased blood flow in the coronary arteries resulting in damaged to the myocardium -> unable to function properly, or die
• ACS is an acute, life threatening, coronary event that requires urgent hospitalization

Question 2

ACS: State the classifications and subtypes

Answer 2

ACS can be classified as

• ST elevation ACS: STEMI
• Non-ST elevation ACS: NSTEMI, Unstable angina

Question 3

Non-ST elevation ACS: causes

Answer 3

• atherosclerotic plaque rupture with thrombus formation -> causing partial obstruction (if it was total, would be STEMI)
• Coronary spasms (usually causes ST elevation, like in prinzmetal angina, if the occlusion is long enough)
• coronary embolism
• Atherosclerosis, causing more than 70% occlusion (like in stable angina, but here not considered as a non-ST elevation ACS)

Question 4

Non-ST elevation ACS: Diagnosis

Answer 4

• family, medical history that could show: HTN, smoke, hypercholesterolemia, DM
• physical examination -> showing any signs of ischemic heart diseases
• ECG: ST depression, deep T inversion. NSTE-ACS, will especially be seen in V2 V4
• Labs: Troponin I,T,C, CK-MB (seen only in NSTEMI, not un unstable angina)

Question 5

Differential diagnosis

Answer 5

• can be any other life-threatening acute chest diseases: pulmonary embolism, aortic dissection, pericarditis

Question 6

What would NSTE-ACS cause ?

Answer 6

• sub-endocardial ischemia -> which depending on the degree of the ischemia, could lead to necrosis -> cause myocardial dysfunction -> possible cardiogenic shock

Question 7

Consequences of NSTEMI

Answer 7

• Subendocardial necrosis -> irreversible injury -> increased biomarkers, ST depression, T inversion, coronary T

Question 8

Biomarkers to be seen in MI: NSTEMI or STEMI

Answer 8

• troponin I, T -> I is the most specific, elevates 2-4 hours, peaks at 48h, stays for 7-10 days
• CK-MB -> second best, elevates 2-4, peaks at 24h, stays for 48h. Useful for detection of a second MI
• LDH -> peaks at 72h, for 10-14 days
• myoglobin