1
Q
ACS includes?
A
unstable angina
NSTEMI
STEMI
2
Q
incidence of STEMI
A
5/1000
3
Q
Pathophysiology
A
- plaque rupture, thrombosis & inflammation
- rarely coronary spasm
4
Q
modifiable risk factors of ACS
A
- HTN
- DM
- Smoking
- ↑cholesterol
- Obesity
5
Q
non-modifiable risk factors of ACS
A
- age
- male
- FH (MI <55 years)
6
Q
symptoms of ACS
A
- Radiates to left jaw or arm
- Nausea
- Sweating
- Dyspnoea
- Palpitations
7
Q
Other symptoms for diabetic patients who may present without chest pain
A
- Syncope
- Delirium
- Post-op oliguria / hypotension
8
Q
signs of ACS
A
- Anxiety
- Pallor Sweating
- Pulse ↑/↓
- BP ↑/↓
- 4th heart sound
- Signs of LVF (basal creps, ↑ JVP, 3rd HS)
- Pansystolic Murmur: papillary muscle dysfunction / rupture
9
Q
differential diagnosis of ACS
A
- Angina
- Peri / endo / myocarditis
- Dissection
- PE, pneumothorax, pneumonia
- Costochondritis
- GI: e.g. GORD, spasm
- Anxiety
10
Q
ECG changes for STEMI
A
- Normal
- ST elevation + hyperacute (tall) T waves
- Q waves: full-thickness infarct
- Normalisation of ST segments
- T wave inversion
- (New onset LBBB also = STEMI)
11
Q
ECG changes for NSTEMI
A
- ST depression
- T wave inversion
12
Q
no Q waves on ECG indicates?
A
subendocardial infarct
13
Q
bloods for ACS
A
- Troponin T/I
- Myofibrillar proteins linking actin and myosin
- Elevated from 3-12h
- need 12h trop to exclude MI
- Peak 24h
- Baseline from 5-14d - FBC, U+E, glucose, lipids, clotting
14
Q
CXR for suspected ACS
A
- Cardiomegaly
- Pulmonary oedema
- Widened mediastinum: aortic rupture
15
Q
diagnose unstable angina when?
A
- typical symptoms
- no ST elevation
- negative troponin
16
Q
treatment for STEMI
A
PCI or thrombolysis
17
Q
treatment for NSTEMI/unstable angina
A
medical + elective angio ± PCI/CABG
18
Q
prognosis of STEMI patients?
A
30 day mortality ~15%
19
Q
prognosis for NSTEMI
A
overall mortality 1-2%
