Myocardial infarction and ACS Flashcards
What is ACS?
ACS is unstable angina and myocardial infarction, occuring due to myocardial ischaemia.
Unstable angina = ishcaemia +/- cell death (no troponin rise)
MI = infarction = cell death and release of troponin
What are the different types of MI?
Type 1 = coronary event
Type 2 = increased O2 demand or decreased supply e.g. HF, anaemia, sepsis, arrhythmia
Type 3 = sudden cardiac death e.g. ruptured AA
Type 4a/b = associated with a) PCI (accidentally block an artery) or b) stent thrombosis
Type 5 = CABG
What is presentation of MI?
acute central chest pain > 20 minutes, nausea, sweating, dyspnoea, palpitations , tachy or bradycardia, anxiety, pallor
What is a silent MI and its presentation?
MI without any chest pain, often elderly/females/diabetics. Syncope, pulmonary oedema, epigastric pain and vomiting, confusion.
What are differentials for MI?
Stable angina, pericarditis, myocarditis, Takotsubo cardiomyopathy, aortic dissection
What is needed for diagnosis of MI?
Rise in troponin, along with either:
- symptoms of ischameia
- ECG changes
- new loss of myocardium
- regional wall motion abnormalities on imaging
What are ECG changes in STEMI?
New (or increased) and persistent ST-segment elevation in two or more contiguous leads
New onset LBBB
T wave inversion and pathological Q waves develop over hours to days
What are ECG changes in NTSEMI?
ST depression
T wave inversion
Often normal
What are the investigations to do?
ECG
Troponin
CXR
Bloods: glucose, cholesterol, anaemia, electrolyte disturbances
What is immediate management of MI
- Morphine
- O2 (if sats <90)
- Anti-emetic
- Heparin
- Aspirin
- Ticagrelor/clopidogrel
- GTN
What are contraindications of fibronolysis?
- Previous ICH
- Recent (<6 months) stroke
- AVM
- Recent trauma or surgery
- Bleeding disorder
What should be done after fibrinolysis?
Repeat ECG at 90 minuets to see if successful.
○ If it has, arrange angiography +/- PCI ○ If not, do a rescue PCI
What are complications of MI?
Arrhythmia (from AF to VF) Heart failure Cardiogenic shock Dressler syndrome LV aneurysm formation
What is secondary prevention of MI?
Antiplatelets Beta blocker ACEi if LV dysfunction Statin Eplerenone if heart failure
What other investigations should be done post MI?
Echocardiogram
