ACS pt1 Flashcards
(49 cards)
What is ACS?
An imbalance between myocardial O2 supply and demand
What makes ACS problems worse?
If the clot(s) occur higher up the arteries of the heart
What differentiates ACS?
The plaque’s fibrous cap ruptures, causing a blood clot
What is type 1 ACS?
Spontaneous MI: atherosclerotic plaque rupture
What is type 2 ACS?
- MI secondary to ischemic imbalance: O2 supply or demand mismatch to heart (ex. vasospasm, anemia, hypotension)
- Rupture hasn’t necessarily happened
What is common epidemiology of ACS?
- Median age is 68 yo
- Males are more likely at a 3:2 ratio
- For some, ACS (like heart attack) is first presentation of CAD
- Approx 70% of pts who experience ACS has a NSTEMI
What are the region and radiation of ACS?
- Retrosternal chest pain
- May radiate to shoulder, down left arm, to back, or jaw
- Most often at REST
What are the s/sx of ACS?
- Nausea, vomiting
- Diaphoresis
- SOB
What patient population are atypical ACS sx more likely in?
- Elderly
- Females
- Diabetics
- Pts w impaired renal function
- Dementia
What are these atypical (noncardiac) sx?
- Epigastric pain
- Indigestion
- Stabbing or pleuritic pain
- Increasing dyspnea in the absence of chest pain
What are high risk features of pts with chest pain?
- Continuing chest pain
- Severe dyspnea
- Syncope/presyncope
- Palpitations
What should be done w pts with chest pain and high risk features?
Transported by emergency medical services
What is the first thing done to all possible ACS pts who arrive at an emergency facility?
All pts w acute chest pain should have an ECG within 10 min of arrival
What does a normal P wave indicate?
The atriums contracting
What does a normal QRS wave indicate?
The ventricles contracting
What does a normal T wave indicate?
The ventricles relaxing
What is a common ECG finding with a STEMI?
ST elevation
What is a possible ECG finding with a STEMI other than a ST elevation?
Q wave change:
- Often not present in initial, develops over hours to days
- Electrical ‘hole’: scar tissue cannot conduct electricity
- May disappear after reperfusion once scarred tissue recovers
- Often remain permanently
What are possible ECG findings with a NSTEMI/UA?
- Normal ECG
- ST depression, transient ST elevation, or new T wave inversion are possible
What does not occur or unlikely to in a NSTEMI/UA ECG?
- Q wave changes unlikely
- No ST elevation
When should troponin be measured?
- Measured asap after presentation of acute chest pain and ACS once arrival to ED
What releases troponin?
Necrotic myocytes (injured heart cells) into bloodstream
What is the gold standard to determine myocardial injury?
Troponin
Which troponin is PREFERRED?
High sensitivity troponin
