Week 5 - Case One Flashcards
what is acute coronary syndrome
an umbrella term for a spectrum of disease caused by ischaemia (and sometimes infarction) of myocardium (loss of blood supply to heart muscle)
it is a medical emergency and requires immediate hospital admission
what is a STEMI
ST elevation MI
how is a STEMI diagnosed
diagnosable on the basis of classical ECG changes
what is an NSTEMI
non-ST elevation MI
how is an NSTEMI diagnosed
usually diagnosed on the basis of a suggestive history, with positive biochemical markers e.g positive troponin
what is unstable angina
ischaemia, without infarction
how is unstable angina diagnosed
no obviously evident ECG changes (there may be some transient changes) , negative troponin, often a history suggestive of ACS. Unstable angina is significant due to the high risk of an MI in the subsequent 30 days.
why are these three conditions grouped together
because they all have a common mechanism, rupture or erosion of the fibrous cap of a coronary artery plaque
what is the textbook presentation of ACS
acute onset central or left sided chest pain, which often comes at rest, in the morning, gradually increasing in intensity over a period of minutes, radiates down the left arm, associated with diaphoresis and pre-syncopal or syncopal symptoms
what percentage of patients present without pain
30%
what is the most common cause of death in the UK
coronary heart disease
what is the epidemiology of MI
50% of deaths occur within 2 hours of onset of symptoms
15% of cases of MI are fatal
what is the incidence of CHD
300,000 cases per year
what is the non-modifiable aetiology
age
gender (male)
FD of IHD (only significant if symptoms presented before the age of 55 in relative)
what are the modifiable risk factors for CHD
Smoking
Hypertension
Diabetes
Hyperlipidaemia
Obesity
Sedentary lifestyle
how does cocaine use cause MI
acutely can cause coronary vasospasm which can cause MI
chronically increases the risk of MI from a traditional atherosclerotic disease process
describe the character of the chest pain seen in CHD
- can radiate down the inside of the arm, and into the neck and jaw and can last up to a couple of hours. may also radiate to the epigastrium or back
when is chest pain more predictive of an MI
if it radiates to both arms or the right arm
what type of pain is it typically described as
a crescendo pain with increasing severity over a period of several minutes after onset
typically a mid range pain e.g 5-7 out of 10
what are the 5 other symptoms associated with ACS, MI
diaphoresis
breathlessness
syncope
tachycardia
vomiting and sinus bradycardia
distress
what does syncope occur as a result of
occurs aș a result of severe arrhythmia or severe hypotension
why may vomiting and sinus bradycardia occur
as a result of excessive vagal stimulation, which is most common in inferior MI
what does sudden death usually occur from
ventricular fibrillation or systole.
why do most MI’s and strokes occur in the morning
because BP lowers during the night, and then rises again in the morning when the person wakes up.
this higher BP may then dislodge any thrombus that has formed over night