Acute Coronary Syndrome (ACS) & Myocardial Infarction (MI)
Summary
Symptoms
Risk Factors
--END OF SUMMARY--
Symptoms
- Central crushing chest pain (may radiate to jaw/ arm(s))*
- Dyspnoea
- Pre-syncope/ Syncope
- n+v
- Sweats
- Palpitations
Risk Factors
- Past Hx of IHD (#1)
- Hypercholesterolaemia (#2)
- Obesity/ Metabolic syndrome
- Hyperlipidaemia
- Diabetes Mellitus
- Hypertension
- Smoking
- FHx
- Cardiogenic shock
- S4
- Bedside: ECG
- Bloods: Troponin, FBC + CRP, UEC, BSL, Lipids
- Imaging: Coronary angiogram, CXR
- Send to hospital
- Onset: MONA -->
- BB/CB (if BB C/I) --> Clexane --> (IV nitrates if pain continues) --> PCI if high risk
- PCI/ Thromolysis (if PCI not available within 2/24)
--END OF SUMMARY--
Definition
Umbrella term for STEMI, NSTEMI & unstable angina.
Not a dx.
Indicates further ix.
Umbrella term for STEMI, NSTEMI & unstable angina.
Not a dx.
Indicates further ix.
Aetiology
Pathogenesis
Clinical Features
Symptoms
Signs
*** Send to hospital ***
M orphine
O xygen
N itrate (SL)
A spirin
then ECG + Cardiac Enzymes.
UA (ST depression), NSTEMI
- Plaque rupture
Pathogenesis
- Plaque rupture --> thrombosis --> inflammation
Clinical Features
Symptoms
- Acute central chest pain >20/60
- Nausea
- Dyspnoea
- Sweatiness
Signs
- Distress
- Anxiety
- Pallor
- 4th heart sound
- Possible signs of heart failure
- Pansystolic murmur
- Bedside: ECG (ST depression/ elevation)
- Bloods: Serial troponin @ onset, 3/24, 8/24, after (elevated = MI), FBC + CRP (inflammation), UEC (renal fn/ E- balance), BSL (DM), Lipids (risk factor)
- Imaging: Coronary angiogram (detect coronary a stenosis), CXR (cardiomegaly/APO/rule out aortic dissection)
*** Send to hospital ***
M orphine
O xygen
N itrate (SL)
A spirin
then ECG + Cardiac Enzymes.
UA (ST depression), NSTEMI
NOTE: Do not use BB and verapamil together. May cause asystole
STEMI
STEMI
ACC/AHA guidelines 2004:
- Door to needle: 30 min
- Door to balloon: 90 min
Secondary prevention:
C lopidogrel
O mega 3
B eta blocker (atenolol/ metoprolol as they are B1 selective)
R amipril/ Trandolapril - longer acting (ACEI)
A spirin
A torvastatin
Complications
STEMI
1. Failure to reperfuse
2. Stroke
3. Pericarditis
4. Cardiogenic shock
5. Heart block
6. Systemic emboli
Source
OHCM 9th Ed 2014
Toronto Notes 2012
Talley & O'Connor 6th Ed 2009
C lopidogrel
O mega 3
B eta blocker (atenolol/ metoprolol as they are B1 selective)
R amipril/ Trandolapril - longer acting (ACEI)
A spirin
A torvastatin
Complications
STEMI
1. Failure to reperfuse
2. Stroke
3. Pericarditis
4. Cardiogenic shock
5. Heart block
6. Systemic emboli
Source
OHCM 9th Ed 2014
Toronto Notes 2012
Talley & O'Connor 6th Ed 2009