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Flashcards in FN: Acute coronary Syndromes Deck (16):
1

Definition

ACS = unstable angina + evolving MI
Divided into:
1. ST elevation or new onset LBBB
NSTEMI

2

Epi

Incidence 5/1000 for STEMI

3

Pathophysiology

1. Plaque rupture, thrombosis and inflammation
2. Rarely due to coronary spasm

4

Risk Factors modifiable

HTN
DM
Smoking
raised cholesterol
Obesity

5

Non-modifiable

Age
Mal
FH (MI ,55yrs)

6

Symptoms

Acute central/left chest pain >20 min
Radiates to left jaw or arm
Nausea
sweating
Dyspnoea
Palpitations

7

Silent MIs in

Elderly/diabetes
1. Syncope
Delirium
Post-op oliguria/hypotension

8

Signs

1. Anxiety
2. Pallor sweating
3. Pulse low or high
4. BP low or high
5. 4th heart sound
6. Signs of LVF (basal creps, raised JVP, 3rd heart sounds)
7. PSM: papillary muscle dysfunction/rupture

9

Differential

1. Angina
2. Peri/endo/myocarditis
3. dissection
4. PE, pneumothorax, pneumonia
5. Costochondritis
6. GI e.g. GORD, spasm
7. Anxiety

10

Investigations

1. ECG
2. Bloods
3. CXR

11

ECG

1. STEMI seqeunce
2. NSTEMI
3. No Q waves = subendocardial infarct

12

STEMI seqeunce

1. Normal
2. ST elevation + hyperacute (tall) T waves
3. Q waves: full-thickness infarct
4. Normalisation of ST segments
5. T wave inversion
6. (New onset LBBB also = STEMI)

13

Bloods show

1. Troponin T/I
a. Myofibrillar proteins linking actin and myosin
b. Elevated from 3-12h therefore need 12h trop to exclude MI
c. Peak at 24hrs
d. Baseline from 5-14d

2. FBC, U + E, glucose, lipids, clotting

14

CXR

Cardiomegaly
Pulmonary oedema
Widened mediastinum: aortic rupture

15

Diagnosis
STEMI/LBBB show
NSTEMI show
UA show

1. STEMI/LBBB: Typical symptoms + ST elevation (/LBBB)
2. NSTEMI: Typical symptoms + no ST elevation + +ve troponin
3. UA: typical symptoms + no ST elevation + ive troponing

16

Treatment

STEMI: PCI or thrombolysis
NSTEMI/UA: medical + elective angio ±PCI/CABG

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