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Flashcards in ACS Deck (61)
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1

ACS includes?

Unstable angina
NSTEMI
STEMI

2

Pathophysiology of ACS

Plaque rupture

Thrombosis and inflammation

Rarely coronary spasm

3

Modifiable risk factors of ACS

- HTN
- DM
- Smoking
- ↑cholesterol
- Obesity

4

Non-modifiable risk factors of ACS

- age
- male
- FH (MI <55 years)

5

Sx of ACS

- Radiates to left jaw or arm
- Nausea
- Sweating
- Dyspnoea
- Palpitations

6

Other symptoms for diabetic patients who may present without chest pain

- Syncope
- Delirium
- Post-op oliguria / hypotension

7

Differential diagnosis of ACS

Angina

Peri- / Endo- / Myocarditis

Aortic dissection

PE

Pneumothorax

Pneumonia

GORD

Anxiety

8

ECG changes for STEMI

- Normal
- ST elevation
- Q waves: full-thickness infarct
- T wave inversion
- New onset LBBB

9

ECG changes for NSTEMI

- ST depression
- T wave inversion

10

No Q waves on ECG indicates?

subendocardial infarct

11

Bloods for ACS

1) Troponin T/I
2) FBC, U+E, glucose, lipids, clotting

12

What is Troponin T/I?

Myofibrillar proteins linking actin and myosin

13

When to measure troponin

Elevated from 3-12h
Need 12h trop to exclude MI
Peak 24h

14

CXR for suspected ACS

- Cardiomegaly
- Pulmonary oedema
- Widened mediastinum: aortic rupture

15

When to diagnose unstable angina

- typical symptoms
- no ST elevation
- negative troponin

16

Rx of STEMI

PCI or thrombolysis

17

Rx of NSTEMI or unstable angina

Medical + elective angioplasty ± PCI/CABG

18

ECG criteria for thrombolyis

- ST elevation > 1mm in 2+ limbs

or > 2mm in 2+ chest leads.
- New LBBB
- Posterior: Deep ST “depression” and tall “R” waves in V1-V3

19

Flow chart of STEMI management

1) 12 lead ECG

2) O2

3) IV access + bloods

4) Brief assessment

5) Aspirin 300mg

6) Morphine + anti-emetic

7) Nitrates

8) LMWH

9) Admit to CCU

10) PCI / thrombolysis

 

20

Complications of PCI

- Bleeding
- Emboli
- Arrhythmia

21

CIs of thrombolysis

Severe HTN (200/120)

Aortic dissection

GI bleeding

22

Agents used in thrombolysis

Alteplase

Rh t-PA

23

What should patients not receiving any form of reperfusion therapy be given?

fondaparinux

24

Continuing therapy following STEMI

Aspirin 300mg 2 wks

Then clopidogrel 75mg (1 month) + aspirin 75mg (lifelong)

ACEi within 24hrs of MI

Beta blocker

Statin

25

Advice following STEMI

- Stop smoking
- Diet
- Exercise

26

How long to avoid work post MI?

2 months

27

How long to avoid sex post MI?

1 month

28

How long to avoid driving post MI?

4 wks

(6 wks if bus or lorry driver)

29

Complications of MI

DRAPPED

Death

Rupture

Arrythmias / Aneurysm

Pericarditis

Pump failure

Embolism

Dressler's syndrome

30

Causes of death from MI

VF
LVF

Stroke