Management Of ACS Flashcards
What are the symptoms and signs of ACS?
Symptoms: chest/back/jaw pain, indigestion, sweatiness, SOB, none, death
Signs: distress, tachycardia, HF, shock, arrhythmia, none
What is the definition of an MI?
Any elevation in troponin in a clinical setting consistent with myocardial ischaemia
Type 1 MI
Spontaneous MI due to primary coronary event (coronary artery plaque rupture and thrombus formation)
Type 2 MI
Increased O2 demand or decreased O2 supply (eg. HF, sepsis, anaemia etc.)
Type 3 MI
Sudden cardiac death
Type 4 MI
A: MI associated with PCI
B: MI caused by stent thrombosis documented by angiography or PM
Type 5 MI
MI associated with CABG
What score is used to risk assess chest pain patients?
- HEART score
- history, ECG, age, risk factors, troponin
What are the non-coronary (type 2) causes of elevated troponin?
- congestive HF (acute decompensation)
- tachyarrhythmias (SVT, AF, VT)
- PE
- sepsis
- apical ballooning syndrome
- anything that stresses the heart
What are the causes of chronic troponin elevation?
- renal failure
- chronic heart failure
- infiltrative cardiomyopathies eg. Haemochromatosis, sarcoidosis etc.
- infiltrative troponin can help separate chronic elevation from MI
What is unstable angina?
- acute coronary event without a rise in troponin
- clinical presentation of MI + ECG changes/tight thrombotic narrowing on coronary angiography
Classify region of infarct and vessel affected
- inferior = RCA or L circumflex
- posterior = circumflex or RCA
- lateral = L circumflex
- anteroseptal = LAD
What characterises LBBB and why is it important to note?
- widened QRS >120ms/3 squares
- can indicate a new infarction
- if old, can obscure an ST elevation during an infarct
What leads correspond to the inferior region of the heart?
II, III and aVF
What leads correspond to the lateral region of the heart?
I, aVL, aVR, V5 and V6
