NSTEMI Flashcards
What are the ECG changes in NSTEMI?
- ST depression
- Flat/inverted T waves
- No changes
- Pathological Q waves - late infarct
What Ix would you order for NSTEMI?
*same like other ACS
- ECG
- FBC (check for anaemia)
- U&Es (prior to ACEi and other meds)
- LFTs (prior to statins)
- Lipid profile
- Troponin test, CK
- Thyroid function tests (check for hypo / hyper thyroid)
- HbA1C and fasting glucose (for diabetes)
- CXR to investigate for other causes of chest pain and pulmonary oedema
- Echocardiogram after the event to assess the functional damage
- CT coronary angiogram to assess for coronary artery disease
What score is used to assess PCI in NSTEMI?
- GRACE Score
What does the GRACE score entails?
- Assess 6months mortality for pts with c ACS
How does the GRACE score work?
- <5% Low Risk
- 5-10% Medium Risk
- >10% High Risk
- If they are medium or high risk they are considered for early PCI (within 4 days of admission) to treat underlying coronary artery disease.
What does the GRACE score include?
- Age
- HR
- Systolic BP
- Creatinine
- Cardiac arrest on admisison
- ST deviation
- Abnormal cardiac enzymes
- Killip class
What is the Killip classifcation used for?
- Quantifies severity of HF in NSTEMI and predicts 30 days mortality
Describe the different classifications in Killip
- I: No signs of congestion:
- <5% 30 days mortality
- II: S3 + basal rales
- 5-10% 30 days mortality
- III: Acute pulmonary oedema
- 10-20%
- IV: Cardiogenic shock
- 10-20%
How would you acutely manage NSTEMI?
- Record ECG
- If SaO2 <90% / breathless - low flow O2
- Morphine 5-10mg IV + Metoclopromide 10mg IV
- GTN spray
- Aspirin 300mg loading and 75mg OD
- Measure troponin & GRACE score
- Start mx for either high risk or low risk pts
What features do high risk pt have?
- Rise in troponin
- ST or T wave changes
- DM, CKD, LVEF < 40%, early angina post MI, recent PCI, prior CABG,
What is the Mx plan for high risk pt?
- Fondaparinux 2.5mg OD SC or LMWH 1mg/kg/12h
- Second platelet
- Ticagrelor 180mg PO
- IV Nitrate if pain continues
- GTN 50mg in 50mL 0.9% saline @ 2-10mL/h
- Bisoprolol 2.5mg OD
- Prompt cardiologist review for angiography
What drug class is fondaparinux?
- synthetic pentasaccharide
- inhibits Xa by binding to ATIII, long half life -18h
What other medications would you consider for NSTEMI?
- ACEi
- Atorvastatin 80mg OD
What are the Cx of MI?
*remember DREAD
- Death
- Rupture of heart sputum
- Edema
- Arryhtmia
- Dressler’s syndrome
What is Dressler’s syndrome?
- Localised immuneresponse post MI causing pericarditis
How long after an MI would dressler’s syndrome normally occur?
- 2-3 weeks
How does Dressler’s syndrome present?
- pleuritic chest pain
- low grade fever
- pericardial rub
- pericardial effusion
How would you dx dressler’s syndrome?
- ECG
- global ST elevation and T wave inversion
- Bloods
- raised CRP and ESR
- Echo
- pericardial effusion
What is the mx for Dressler’s syndrome?
- NSAIDs
- steroids
- pericardiocentesis
What are the medical options for secondary prevention of MI?
*6As
- Aspirin 75mg OD
- Another anitplatelet: clopidogrel or ticagrelor - up to 12months
- Atorvastatin 80mg OD
- ACEi - as tolerated. up tp 10mg OD
- Atenolol
- Aldosterone antagosist (eg; eplerenone - up to 50mg OD)
