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Medicine Notes Cardiology Notes

Acute Coronary Syndrome Notes

Updated Acute Coronary Syndrome Notes

Cardiology Notes

Cardiology

Approximately 27 pages

Complete set of notes on Cardiology. COvering all the main conditions with pathophysiology, presenting symptoms, investigation and management. Includes relevant pharmacology. Clear headings and concise bullet points, including table summaries. ...

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The following is a more accessible plain text extract of the PDF sample above, taken from our Cardiology Notes. Due to the challenges of extracting text from PDFs, it will have odd formatting:

Acute Coronary Syndrome

ACS = term covers

  • Unstable angina

  • NSTEMI

  • STEMI

Risk factors

Non-modifiable Modifiable

  • Smoking

  • Hypertension

  • Diabetes

  • Hyperlipidaemia

  • Obesity

  • Sedentary lifestyle

  • Age

  • Gender

  • Family history (1st degree relative < 55yrs)

Pathogenesis

  • Myocardial ischaemia occurs when there is an imbalance between the supply of O2 + myocardial demand for it

  • Coronary blood flow to a particular region of the heart may be reduced by

    • Mechanical obstruction e.g atheroma, thrombosis, spasm, embolus

    • Decreased flow of oxygenated blood e.g anaemia, hypotension

  • Increased myocardial demand for O2 may be caused by

    • Increased cardiac output e.g thyrotoxicosis

    • Myocardial hypertrophy

  • Myocardial ischaemia most commonly occurs from obstructive CAD in the form of coronary atherosclerosis

Process of atherosclerosis

Endothelial injury

Result of mechanical stresses e.g hypertension

Biochemical abnormalities e.g raised LDL, DM

Immunological factos e.g free radicles from smoking

Genetic alteration

Accumulation of lipids and macrophages leads to foam cells

Form the fatty streak

Cytokine release causes further accumulation of macrophages

+ SMC migration and proliferation

= Plaque

Plaque becomes unstable

Rupture

Thrombosis

Obstruction

Diagnosis

  • Need to have two or more of the following

    • Typical history

    • ECG changes

    • Raised cardiac enzymes

Clinical features

  • Symptoms

    • Acute central chest pain >20mins

    • Associated N+V, sweating, SOB, palpatations

    • Pain can radiate to jaw, left arm

NB – in elderly/diabetics may be no symptoms (silent infarct) therefore suspect with varied presentations, e.g syncope, pulm. Oedema, acute confusion etc

Signs

  • Distress

  • Anxiety

  • Pallor

  • Sweating

Investigations

ECG

STEMI

Immediately

  • Hyperacute peaked T waves

Mins-hours

  • ST elevation +/- T wave inversion

Days

  • STs fall, Q waves develop

Months

  • Pathological ‘old infarct’ Q waves

  • >1 little square wide

  • >2mm depth

NSTEMI + Unstable angina

May be

  • ST depression

  • T wave inversion

  • Non-specific changes

  • Normal

Localising STEMI

  • Anteroseptal = V1-V4 (LAD)

  • Inferior = II, III, aVF (RCA)

  • Anterolateral = I, aVL, V5, V6 (circumflex)

  • Posterior = tall R + ST depression in V1-2 (RCA, circumflex) Difficult to see

CXR

  • Signs of HF

  • Rule out any differentials

Bloods

  • FBC, U+E, hyperglycaemia, TFTs, lipids (LDH) raised cardiac enzymes (trops, ck-mb, LDH)

Management

  • Pre-hospital

    • 300mg aspirin chewed

    • GTN sublingual spray (unless hypotensive)

    • Analgesia + antiemetic e.g 5-10mg morphine...

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