Acute Coronary Syndromes
Acute coronary syndromes comprise
- Unstable Angina
- Non-ST segment elevation MI
- ST segment elevation myocardial infarction
Fissure of atheromatous plaque > Haemorrhage into plaque > contraction of lumen of wall + thrombus formation in wall
Diagnosis
History
Clinical examination
12-Lead ECG: ST elevation, TWI, posterior MI
Lab tests: Troponins, CK, LDH, AST
Echocardiography
Treatment (OMAN)
Oxygen
Morphine + Metoclopramide
Aspirin 300mg
Nitrates (titrate to BP)
A - STEMI: Reperfusion (1) Percutaneous coronary intervention - PCI (2) Thrombolysis
B - NSTEMI: Prevent further thrombus (1) LMWH (2) Clopidogrel 300/600/900mg (3) GpIIb/IIIa - Tirofiban
Reduction in O2 demand (1) B-blockers (2) ACEi
Complications (Sudden Death on PRAED ST)
Sudden death
Pericarditis
Ruptured
Aneurysm
Embolus
Dressler's
Heart failure
Cardiogenic Shock
Arrythmias
Cardiac Rehabilitation
Secondary prevention
Anti-thrombotic therapy (Asp/Clopi)
Preseveration LV function - ACEi (incl echo)
Reduction of cholesterol
Avoidance of smoking
Anti-hypertensives
