Acute Coronary Syndrome Flashcards
(19 cards)
What is ACS
Acute coronary syndrome
Basically, no blood to heart, no o2, possible death
SUN!! The three types of ACS are what?
Stems
Unstable angina
N-stemi
How is diagnosis made?
It’s made on the basis of clinical presentation, ECG changes and measurement of biochemical cardiac markers such as troponin
Normal ecg
So on a normal ecg, the ST region should be flat, if its elevated that means that there is a heart attack taking place
Stemi stands for what?
St Elevation Myocardial infarction (elevation to heaven)
What causes ACS?
Angina - when heart does not get enough o2, chest pain usually treated with GTN
Stemi - most serious (full block and no o2 = heart cell death)
Nstemi - Not Serious = blockage is partial, still surviving and only a partial block
Nstemi or Angina can become what?
They can become a Stemi, they’re a partial block but the block can become full
What causes an ACS
Plaque ruptures from within a coronary artery, this will cause a partial or complete block of the artery.
Obstruction restricts the blood supply to the heart, restricting the amount of oxygen - leading to Ischaemic (chest pain and angina)- angina is often the first sign
If obstruction is serious, some of the heart muscle begins to die = necrosis
Stemi = Serious and its the worst form of ACS
ST region will appear elevated on ECG - indicating a classic complete block of the coronary artery = cardiac death of muscle
NSTEMI=
Partial Heart attack
- Inbetween an unstable angina and a Stemi
- partial obstruction of coronary artery, some muscle cells die and most survive
What are angina symptoms?
Angina = chest pain
Chest pain that is tight,sharp,stabbing, dull and heavy
- spreads from left arm, neck jaw and back
- triggered by physical excretion and stress
- stops within a few mins of rest
- fatigue
- SOB
-sweating
- dizziness
What’s the difference between stable and unstable angina?
Stable - we know so symptoms will occur during exercise, activity,stress and stops when you rest so its very predictable
Unstable - chest pains that happen during rest and more severe. Unstable = unpredictable
What’s the medication management of ACS
GTN(Sublingual and buccal ) - Given for immediate pain relief ASAP (iv opioid may be used, eg. Iv morphine especially in an MI )
Aspirin - 300mg ASAP - which can be chewed
Oxygen is feeder
- Insulin if hyperglycaemia - if glucose is more than 11mmol/l
Initial Stemi treatment
- Aspirin 300mg+ clopidogrel/prasugrel/icagrelor
- heparin unfractionated( if there’s significant renal impairment)
What is used as secondary prevention for ACS?
1) Cardiac rehab- lifestyle interventions
2) AceI/Arb + BB ( alternative would be digoxin/verapamil - if there’s significant renal is no pulmonary congestion or reduced LVEF)
- dual anti platelet therapy
Eg. Aspirin and clopidogrel for 12 months
Or
Dual/triple therapy with an anti coagulant - if there’s increased cardiac biomarkers
(Eg. Aspirin/+ clopidogrel + Rivaroxaban
+ statins if there’s significant clinical evidence of CVD
Stable Angina long term treatment
1) Beta blocker (atenolol,bisoprolol): Rate limiting calcium channel blocker if beta blocker contraindicated eg. Decompensated severe HF
It’s usually a dihydropyridine CCB
In addition to BB+CCB
Add/-
1) Long acting nitrate
Or
2) Ivabradine
Or
3) Nicorandil
Or4) Ranolazine
We want to give either one oof these as monotherapy if BB/CCB is contraindicated, if 2 fail then specialist referral
Secondary prevention for stable Angina and prevention of CVD events-
Life style, low dose aspirin,statins, ace i (especially for diabetes)
NStemi treatment
A FAT BAT (for NSTEMI initial and ongoing management):
• A – Aspirin (loading dose, then maintenance)
• F – Fondaparinux (or another anticoagulant like LMWH)
• A – Antiplatelet (usually clopidogrel or ticagrelor)
• T – Ticagrelor (if not already covered above, this reminds you to consider dual antiplatelet therapy)
• B – Beta-blocker (if no contraindications like heart failure, asthma, bradycardia)
• A – ACE inhibitor (start once stable)
• T – Statin (high-intensity, like atorvastatin 80 mg)
The acronym you’re thinking of for initial treatment of an ACS (including NSTEMI and STEMI) is commonly:
MONA
The acronym you’re thinking of for initial treatment of an ACS (including NSTEMI and STEMI) is commonly:
MONA
It stands for:
• M – Morphine
• O – Oxygen (if SpO₂ < 94%)
• N – Nitrates (usually sublingual GTN)
• A – Aspirin (usually 300 mg loading dose)
