Acute Coronary Syndrome Flashcards
(15 cards)
Define STEMI - ST-elevation myocardial infarction
heart attack caused by a complete blockage of one or more coronary arteries, leading to transmural (full-thickness) myocardial ischaemia and injury or necrosis of the heart muscle
STEMI ECG criteria
ST elevation in ≥2 contiguous leads:
- ≥1 mm (other leads)
- V2–V3: ≥2 mm (men ≥40), ≥2.5 mm (men < 40), ≥1.5 mm (women)
New/presumed new LBBB (with symptoms)
Posterior MI
- ST depression V1–V3 with tall R waves; consider posterior leads
STEMI Management
Initiate Aspirin 300mg loading dose
Angiography + PCI if presented within 12hrs of Sx and PCI in 120mins
Prasugrel + Aspirin OR Clopidogrel + Aspirin if already on anticoagulant
OR
Fibrinolysis if PCI not possible in 120mins
Ticagrelor + Aspirin OR Clopidogrel + Aspirin if already on anticoagulant
OR
Medical Mx if presented after 12hrs Aspirin + Ticagrelor OR Aspirin + Clopidogrel if on coagulant + cardio assesment + Echo for LV function
Post STEMI managment
Cardiac Rehab (initiate before discharge)
- Lifestyle changes (smoking cessation, alcohol, exercise, Meditrerranean diet)
Secondary prevention
- Aspirin + Ticagrelor OR Clopidogrel if already on coagulant (12 months)
- Anti-hypertensive: ACE-i / ARBs to optimise BP
- Beta blocker: to reduce afterload
- High dose statin: Atorvastatin 80mg
Define NSTEMI - Non ST-elevation myocardial infarction
NSTEMI occurs when there is a partial or transient occlusion of a coronary artery, leading to myocardial injury but without the full-thickness (transmural) ischaemia
NSTEMI ECG criteria
ST-segment depression: Horizontal/downsloping, ≥0.5 mm, ≥2 contiguous leads
T-wave inversion/flattening: ≥1 mm, ≥2 contiguous leads
Transient ST elevation: May occur, but not persistent
Normal/non-specific ECG Possible, especially early
NSTEMI/Unstable Angina Management
Initiate Aspirin 300mg loading dose
Initiate Fondaparinux unless high bleeding risk or stat angiography
GRACE ≤ 3% Conservative Mx with Aspirin + Ticagrelor OR Clopidogrel if already on anti-coagulant
GRACE > 3% Stat angiography if unstable OR if stable - angiography +/- PCI within 72 hrs
and then
Prasugrel / Ticagrelor + Aspirin OR Asprin + Clopidogrel if already on anticoagulant
A 56-year-old gentleman presents to the Emergency Department with crushing chest pain. On examination, you note hyperhidrosis, an elevated JVP, and bradycardia. Observations show a heart rate of 50 and blood pressure of 90/60. An ECG confirms that the patient has suffered from a STEMI.
Given the clinical findings, which artery is most likely occluded in this patient?
Proximal right coronary artery - AV node is supplied by the right coronary artery
How to distinguish unstable angina from NSTEMI?
Unstable angina: No changes in Troponin
NSTEMI: Rise in Troponin
MI location on ECG
Big LII - I, II, III
Small LI - aVR, aVL, aVF
ASS UP - V1, V2, V3
ALLdown - V4, V5, V6
DVLA rules for Myocardio Infarction
You don’t need to tell DVLA if you’ve had a heart attack (myocardial infarction) or a heart, cardiac or coronary angioplasty.
However, you should stop driving for:
- 1 week if you had angioplasty, it was successful and you don’t need any more surgery
- 4 weeks if you had angioplasty after a heart attack but it wasn’t successful
- 4 weeks if you had a heart attack but didn’t have angioplasty
How to differentiate acute mitral regurg and VSD post PCI?
VSD - occurs within days post PCI
Acute mitral regurg - occurs after a week post PCI
what is the first line treatment for post-infarction percarditis or Dressler’s syndrome for patients who are already on Anti-PLT?
High dose Aspirin for 1-2/52
What drug class are clopidogrel, ticagrelor and prasugrel?
P2Y12Y inhibitor
