Describe the common symptoms of ischaemic chest pain
Radiation (not always present) to inner left arm, (also sometimes abdomen, neck)
Crushing, band-like, heavy
Duration: remits with rest if exerton related
Exacerbating factors: exercise, stress, tachycardia
Relieving factors: rest, GTN
What features may be seen on examination in a patient with ischaemic chest pain?
If symptoms have settled, examination often normal.
- Cold/clammy skin
- Central or peripheral cyanosis, low SpO2
- Bibasal crackles (left ventricular failure)
- Raised JVP (right ventricular failure)
- Hepatomegaly (right ventricular)
- Pedal lower limb and sacral oedema (right ventricular failure)
- Mitration regurgitation (3rd and 4th heart sounds) (damage to papillary muscles)
What are the main differences between unstable angina, NSTEMI and STEMI?
- Clinical entity (no pathological damage to cardiac muscle)
- Pain at rest or with minimal exertion
- No major ECG changes, changes may be non-specific
- Troponin normal
- No infarction, does not involve necrosis
- Clino-pathological entity
- Ischaemic damage to cardiac muscle, subendocardial not transmural
- ECG changes often show ST depression +/- T-wave inversion
- ECG changes may be non-specific
- History may be similar to UA
- Troponin rises then falls
- Infarction and necrosis of cardiac muscle, often transmural
- Persistent ST-elevation on ECG
- Troponin raised
- Symptoms more severe than NSTEMI or UA
What potential consequences are associated with acute coronary syndromes?
- Cardiogenic shock
- Conduction defects
- Ventricular aneurysm
- Cardiac rupture
- Mural thrombosis
- Post MI (Dressler's) syndrome
What else can cause a raised troponin?
In the absence of other causes however it is highly specific and sensitive to ischaemic myocardial damage.
Describe the phases of acute MI
Ischaemic phase (acute phase):
- Myocardium survives on anaerobic metabolism initially
- Anaerobic metabolism cannot keep up with metabolic demand- irreversible damage and cell death occur
What are pathological Q waves associated with?
- NSTEMI or STEMI
What would ST elevation in V1-V6 indicate?
(V1-V4 extensive anterior)
What is used in primary and secondary prevention of ACS?
What is used in the treatment of ACS?
What is used to treat the complications associated with ACS?