Flashcards in ACS Physiology and Pharmacology Deck (11):
What spectrum do clinical features for ACS fall on?
What is the most important distinguishing feature?
Spectrum: From unstable angina to NSTEMI to STEMI
Distinguishing: ST elevation on ECG
What are the clinical features of unstable angina? (4)
Sudden increase in frequency, duration, and/or intensity of ischemic episodes
Episodes of angina at rest
New onset of angina episodes
Not relieved by usual doses of nitroglycerin
What are the clinical features for Acute MI:
C: Severe, persistent, typically substernal
S: Diaphoresis, cool and clammy skin
P: Nausea, vomiting, weakness
I: Mild fever
C: S4 (and S3 if systolic dysfunction) gallop, Dyskinetic bulge (if anterior wall MI), Systolic murmur (if mitral regurgitation or VSD)
O: Pulmonary rales (if heart failure present), JVD (if heart failure or right ventricular MI)
What is the diagnosis of ACS based on?
Acute ECG abnormalities
Detection of specific biomarkers of myocardial necrosis
What are the ECG abnormalities of a UA/NSTEMI?
What are ECG abnormalities for a STEMI?
ST segment depression and/or T wave inversions
May be transient and correlate with chest pain for UA or persist for NSTEMI
Initial ST elevation, followed by T wave inversion over the course of hours and Q wave development (persists for weeks)
What are the serum markers of infarction?
When do they rise and peak?
Which is more specific?
Cardiac troponins - Begin to rise at 3-4 hours, peak 18-36h
Creatine kinase - CK-MB isozyme mainly, begins to rise at 3-8 h, peaks at 24 h, worse specificity
No serum markers for UA
What is the pain distribution of UA versus MI?
UA - Crescendo, rest, or new-onset severe angina
NSTEMI - Prolonged crushing chest pain, more severe and wider radiation than usual angina
What is the goal of therapy?
What is the difference for STEMI?
Address the intracoronary thrombus, provide anti-ischemic measures, limit myocardial damage and complications
STEMIs have total coronary occlusion and benefit the most from immediate reperfusion therapies
What classes of drugs are used for treatment?
Anti-ischemia: Beta blockers, Nitrates, Maybe calcium channel blocker (not much survival aid, mainly for vasospasm)
Pain control (morphine is first choice)
Supplemental O2 as necessary
Statin and ACE inhibitor as adjunctive therapy
Management post-MI involves what therapy? (4 drugs)
ACE Inhibitor (If LV dysfunction)