Acute Coronary Syndrome Overview
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Questions and Answers

What is the primary goal in the management of STEMI?

  • To ensure pain management with narcotics
  • To conduct a thorough patient history and physical exam
  • To open the infarct related artery as soon as possible (correct)
  • To monitor cardiac enzyme levels regularly
  • Which type of myocardial infarction is related to stent thrombosis?

  • Type 4 MI (correct)
  • Type 2 MI
  • Type 1 MI
  • Type 3 MI
  • What ECG finding is compatible with STEMI?

  • T wave inversion in anterior leads
  • ST depression in V1 and V2
  • Pathological Q waves in the inferior leads
  • ST elevation >2mm in 2 contiguous leads (correct)
  • Which of the following is considered a risk associated with fibrinolytic therapy?

    <p>Major non-cerebral bleeding</p> Signup and view all the answers

    What is the significance of obtaining vitals including blood pressure in both arms?

    <p>It assesses for potential aortic dissection</p> Signup and view all the answers

    What type of chest pain is typically associated with STEMI?

    <p>Ischemic type chest pain</p> Signup and view all the answers

    Which of the following treatments has a higher success rate in restoring vessel patency for STEMI?

    <p>Primary PCI</p> Signup and view all the answers

    What is the role of troponin testing in the assessment of acute chest pain?

    <p>To assess for myocardial injury</p> Signup and view all the answers

    What is the primary cause of Acute Coronary Syndromes?

    <p>Rupture of an atherosclerotic plaque</p> Signup and view all the answers

    Which ECG change is characteristic of ST Elevation Myocardial Infarction (STEMI)?

    <p>Significant ST-segment elevation in two contiguous leads</p> Signup and view all the answers

    What distinguishes Non ST Elevation Myocardial Infarction (NSTEMI) from STEMI?

    <p>Nonspecific ECG changes</p> Signup and view all the answers

    What symptom is most commonly associated with ST Elevation Myocardial Infarction (STEMI)?

    <p>Severe and prolonged chest pain</p> Signup and view all the answers

    Which of the following factors indicates a myocardial infarction according to the classification?

    <p>Development of pathologic Q waves on the ECG</p> Signup and view all the answers

    Which statement best describes unstable angina?

    <p>It occurs without evidence of myocardial necrosis.</p> Signup and view all the answers

    What is a characteristic feature of Type 1 Myocardial Infarction (MI)?

    <p>Pathologic process in the coronary artery wall</p> Signup and view all the answers

    When is myocardial infarction classified as Type 2?

    <p>It is due to a critical imbalance in myocardial oxygen supply and demand.</p> Signup and view all the answers

    Study Notes

    Acute Coronary Syndrome

    • Encompasses symptoms and clinical findings with acute myocardial ischemia
    • Usually precipitated by acute thrombosis from a ruptured or eroded atherosclerotic coronary plaque (unstable plaque) and coronary thrombosis
    • Spectrum includes ST Elevation MI (STEMI), Non ST Elevation MI (NSTEMI), and Unstable Angina (UA)

    ST Elevation MI (STEMI)

    • Complete blockage of a coronary artery
    • Specific ECG changes: significant ST-segment elevation in two contiguous leads
    • Often presents with severe prolonged chest pain (may radiate to arms/jaw/back), shortness of breath (SOB), sweating (diaphoresis), nausea/vomiting (N/V)

    Non ST Elevation MI (NSTEMI)

    • Partial blockage of a coronary artery
    • Nonspecific ECG changes: ST-segment depression, T-wave inversion, or no changes
    • Symptoms similar to STEMI, may be less severe

    Unstable Angina (UA)

    • New onset angina, increasing angina, or angina at rest
    • Reflects a significant disruption in coronary artery blood flow without evidence of myocardial necrosis

    Myocardial Infarction

    • Defined as a rise and/or fall of cardiac biomarkers PLUS one of:
      • Symptoms of ischemia
      • Development of pathologic Q waves on the ECG
      • New or presumed new ST changes on ECG or new Left Bundle Branch Block (LBBB)
      • Identification of intracoronary thrombus by angiography or autopsy
      • Imaging evidence of new loss of viable myocardium or new regional wall motion abnormality
    • Classification of Myocardial Infarction includes:
      • Type 1 MI: pathologic process in the wall of the coronary artery (plaque rupture, fissuring, dissection)
      • Type 2 MI: results from a critical imbalance between myocardial oxygen supply and demand (coronary spasm, anemia, arrhythmias, hypotension, hypertension, respiratory failure)
      • Type 3 MI: MI resulting in death for which cardiac enzymes are not available
      • Type 4 MI: MI related to PCI/stent thrombosis
      • Type 5 MI: MI related to CABG

    Approach to Acute Chest Pain

    • Differential diagnosis includes: acute coronary syndrome, aortic dissection, pulmonary embolism, pneumothorax, pericarditis/cardiac tamponade/myocarditis, esophageal spasm, GERD, mediastinitis, respiratory tract infections, asthma exacerbations, musculoskeletal causes, anxiety.

    Immediate Management

    • Monitor vital signs, including blood pressure in both arms
    • Administer supplemental oxygen if SpO2 <90%
    • Establish intravenous (IV) access
    • Obtain electrocardiogram (ECG) within 10 minutes of medical contact
    • Obtain medical history and perform a physical examination
    • Order complete blood count (CBC), electrolytes, blood urea nitrogen (BUN), creatinine (Cr), troponin, creatine kinase (CK), and chest x-ray (CXR)

    STEMI Management

    • Primary goal is to open the infarct-related artery as quickly as possible to restore perfusion using either primary percutaneous coronary intervention (PCI) or fibrinolytic therapy
    • Factors determining treatment strategy include patient presentation, risk factors, and time from onset of symptoms to receiving treatment

    NSTEMI Management

    • Treatment strategy depends on the TIMI (Thrombolysis in Myocardial Infarction) risk score, which assesses risk factors for adverse outcomes
    • Consider a less aggressive strategy than STEMI, including medical therapy, if the risk score is low. Conversely, more aggressive treatment such as early invasive management (coronary angiography and revascularization) is considered if the score is high.

    Causes of Elevated Troponin

    • Cardiac muscle damage releases troponin into the bloodstream
    • Potential causes of elevated troponin include critical illnesses (e.g., diabetes, respiratory failure, sepsis), pericarditis/myocarditis, and situations where the heart has to work harder (e.g., exertion, hypertensive crisis).

    Surgical Revascularization (CABG)

    • Used to improve blood flow to the heart muscle in individuals with significant coronary artery disease (CAD) by creating new pathways for blood flow.
    • Suitable for cases involving complex CAD, particularly if there are multiple vessel involvements or impaired left main coronary artery or left ventricular dysfunction.

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    Description

    This quiz explores Acute Coronary Syndrome, including its symptoms, clinical findings, and the spectrum of conditions like STEMI, NSTEMI, and unstable angina. Test your knowledge on the causes, presentations, and ECG changes associated with these critical cardiovascular events.

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