Unstable Angina & Acute Myocardial Infarctions Flashcards
What is Acute Coronary Syndrome (“ACS”)
An umbrella term encompassing all forms of unstable coronary disease including:
1) Unstable Angina (UA)
2) Non-ST segment Elevation MI (NSTEMI)
3) ST Segment Elevation MI (STEMI)
What is a Myocardial Infarction?
Myocardial cell death caused by prolonged inadequate O2 supply coupled with impaired removal of accumulated tissue metabolites
Stable Angina
fixed supply, increased demand
Unstable Angina/NSTEMI
fixed demand, unstable supply
What is unstable Angina/NSTEMI?
An anginal syndrome characterized by:
- New onset angina with minimal activities
- Previously stable angina now occurring with less and less activity
- Rest angina
How do you distinguish between UA and NSTEMI?
UA and NSTEMI can not be differentiated by History and Physical alone: Initial treatment is the same for both but EKG and blood tests are required to distinguish UA from NSTEMI
Define Lower Risk Unstable Angina
No EKG changes or blood tests with markers of micro-injury
Define High Risk Unstable Angina
EKG changes alone
What is an NSTEMI?
Any unstable coronary syndrome with a Troponin level above the upper limit of normal is now called an NSTEMI
What are the EKG changes seen in a UA/NSTEMI?
T wave inversions
ST Segment depression
What type of medical therapy is NOT indicated in a patient with UA/NSTEMI?
Thrombolytic therapy
Describe some of the characteristics of a medical history given by patients with a ST Elevation Myocardial Infarction
“Crushing sub-sternal pain”, “The worst pain ever”, with radiation to arm(s), neck, jaw; sustained for >20 minutes
Patients may present sweating, anxious, with shortness of breath, with nausea, and vomiting
Myoglobin Lab Test
Rises within 4 hours, but not specific
Troponin I
Very specific, very sensitive
Rises after approximately 8 hours
Rise can last for >5 days
CPK-MB
The classic definer of MI
Rises after approximately 8 hours
Normalizes after approximately 3 days
