Acute cardiac problems Flashcards
(41 cards)
What are the 3 types of ACS
Unstable Angina
ST Elevation Myocardial Infarction (STEMI)
Non-ST Elevation Myocardial Infarction (NSTEMI)
What is acute coronary syndrome
Ischaemia to the heart muscle usually as a result of a thrombus (usually made of platelets) from an atherosclerotic plaque blocking a coronary artery.
What does the left coronary artery become
left anterior descending and circumflex
What does the right coronary artery supply
Right atrium
Right ventricle
Inferior aspect of left ventricle
Posterior septal area
What does the LAD supply
Anterior aspect of left ventricle
Anterior aspect of septum
What does the circumflex supply
Left atrium
Posterior aspect of left ventricle
What features are required to diagnose a STEMI
- ST elevatinon
- New LBBB
- Raised troponins
What features are required to diagnose an NSTEMI
- ECG Changes: ST depression, T wave inversion, pathological Q waves
- raised troponins
What features are required to diagnose unstable angina
- May have ECG changes
- Troponins are NOT raised
What are the symptoms of ACS
Central crushing chest pain lasting for >20 mins with:
- Nausea and vomiting
- Sweating and clamminess
- Feeling of impending doom
- Shortness of breath
- Palpitations
- Pain radiating to jaw or arms
Name other causes of raised troponins
Chronic renal failure Sepsis Myocarditis Aortic dissection Pulmonary embolism
Which vessel is involve in anterolateral ischaemia
- Lead I, aVL, V3-6
- LCA
Which vessel is involve in anterior ischaemia
- V1-4
- LAD
Which vessel is involve in lateral ischaemia
- I, aVL, V5-6
- Circumflex
Which vessel is involve in inferior ischaemia
- II, III, aVF
- RCA
Other than troponins and ECG what other investigations should you do in ACS
Physical Examination: heart sounds, signs of heart failure, BMI
FBC: anaemia
U&Es: prior to ACEi and other meds
LFTs: prior to statins
Lipid profile
Thyroid function tests (check for hypo / hyper thyroid)
HbA1C and fasting glucose (for diabetes)
What imaging should you obtain in ACS
Chest xray: other causes of chest pain & pulm oedema
Echocardiogram: assess the functional damage
CT coronary angiogram: assess for coronary artery disease
What is the Management of an acute STEMI
Presentation within 12 hours of onset
- Primary PCI (if available within 2 hours of presentation)
- Thrombolysis (if PCI not available within 2 hours)
- discuss with local cardiac centre as to whether they want aspirin/ticegralor etc
What is PCI
Percutaneous Coronary Intervention (PCI) involves putting a catheter into the patient’s brachial or femoral artery, feeding that up to the coronary arteries under xray guidance and injecting contrast to identify the area of blockage. This can then be treated using balloons to widen the gap or devices to remove or aspirate the blockage. Usually a stent is put in to keep the artery open.
What is thromblyisis
njecting a fibrinolytic medication (they break down fibrin) that rapidly dissolves clots. There is a significant risk of bleeding which can make it dangerous. Some examples of thrombolytic agents are streptokinase, alteplase and tenecteplase.
Acute management of an NSTEMI
B; beta blockers A: Aspirin 300mg (Stat) T: Ticegralor/clopidogrel 180/300mg (stat) M: morphine A: Anticoagulant: LMWH N: nitrates Oxygen if sats <95%
What is the Grace score
6-month risk of death or repeat MI after having an NSTEMI: <5% Low Risk 5-10% Medium Risk >10% High Risk If medium, PCR within 4 days
What are the complications of MI/HF
D – Death R – Rupture of the heart septum or papillary muscles E – “Edema” (Heart Failure) A – Arrhythmia and Aneurysm D – Dressler’s Syndrome
What is Dresslers Syndrome/post-myocardial infarction syndrome
- Localised immune response causing pericarditis 2-3 post MI
