week 10 Cardiovascular System: STEMI and Coronary Artery Occlusion

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Questions and Answers

What is the primary difference between STEACS and NSTEACS?

The degree of obstruction and necrosis

What is the criterion to differentiate between UA and NSTEMI?

Troponin levels

What is the consequence of myocardial ischemia in terms of cell death?

Apoptosis and necrosis

What is the term for the type of myocardial infarction characterized by ST-elevation or new left bundle branch block (LBBB)?

ST-elevation ACS (STEACS), also known as ST-elevation myocardial infarction (STEMI) Signup and view all the answers

What is the cause of Non-ST-elevation ACS (NSTEACS)?

Partial occlusion of the coronary artery Signup and view all the answers

What is the consequence of myocardial ischemia in terms of cardiac function?

Impairment of myocardial contraction and relaxation, leading to pump failure Signup and view all the answers

What is the Sgarbossa criteria used for?

Diagnosing STEACS in the presence of left bundle branch block (LBBB) Signup and view all the answers

What is the term for the type of myocardial infarction characterized by T-wave inversion and/or ST depression?

Non-ST-elevation ACS (NSTEACS), which includes Unstable Angina (UA) and Non-ST Elevation Myocardial Infarction (NSTEMI) Signup and view all the answers

What is the consequence of myocardial ischemia in terms of arrhythmia?

Ionic and biochemical alterations leading to unstable electrical substrate and ventricular tachyarrhythmias Signup and view all the answers

What are some non-ACS causes of elevated cardiac troponin (cTn)?

Stroke, sepsis, hypoxia, and pulmonary embolism Signup and view all the answers

What are the symptoms of acute coronary syndromes?

Radiating pain to the left arm, jaw, back, shortness of breath/dyspnea, cool, sweaty, clammy, pale, lightheaded Signup and view all the answers

What is silent ischemia?

Episodes of ischemia in the absence of chest pain, presenting with anginal equivalents Signup and view all the answers

Which populations are at risk for silent ischemia?

Diabetics, women, women with heart failure, hypertension, and chronic renal disease/end-stage renal disease Signup and view all the answers

What are the non-modifiable risk factors for acute coronary syndromes?

Family history, A&TSI, increasing age (females), male sex Signup and view all the answers

What are the modifiable risk factors for acute coronary syndromes?

Smoking, hypertension, diabetes, dyslipidemia, obesity, obstructive sleep apnea Signup and view all the answers

What are the contributing factors to acute coronary syndromes?

Sedentary lifestyle, stress, depression Signup and view all the answers

What are the ischemic cardiovascular causes of acute coronary syndromes?

ACS, stable angina, severe aortic stenosis, tachyarrhythmia Signup and view all the answers

What are the non-cardiovascular causes of acute coronary syndromes?

Gastrointestinal, musculoskeletal, pulmonary, herpes zoster Signup and view all the answers

What is the importance of early access to a defibrillator in acute coronary syndromes?

Prevents sudden cardiac death Signup and view all the answers

What is the recommended initial treatment for acute coronary syndromes?

Aspirin (300mg) should be given early Signup and view all the answers

What is the goal of prehospital treatment for chest pain?

Fibrinolysis Signup and view all the answers

What is the recommended timeframe for performing an ECG in acute chest pain management?

Within 10 minutes Signup and view all the answers

scarbossa criteria

Concordant ST Elevation ≥ 1 mm in leads with a positive QRS complex 5 Concordant ST Depression ≥ 1 mm in V1, V2, or V3 3 Excessively Discordant ST Elevation ≥ 5 mm in leads with a negative QRS complex 2 Signup and view all the answers

STEACS management

Antiplatelet therapy: Aspirin and P2Y12 inhibitors Pain relief: Sublingual and intravenous nitrates, opioid analgesia Anticoagulant therapy: Unfractionated heparin or low-molecular-weight heparin Reperfusion therapy: Primary PCI or fibrinolytic therapy Primary PCI Within 90 min of first medical contact Fibrinolytic therapy: Door to needle time” 30 min Signup and view all the answers

Study Notes

Acute Coronary Syndromes (ACS)

ACS includes ST-elevation ACS (STEACS) and Non-ST-elevation ACS (NSTEACS)
STEACS is characterized by ST elevation or new left bundle branch block (LBBB)
NSTEACS is caused by a partial occlusion of the coronary artery, resulting in T-wave inversion and/or ST depression

Terminology

All ACS types have a similar presentation and result from plaque disruption and thrombus formation
The primary difference between ACS types is the degree of obstruction and necrosis

Signs and Consequences of STEACS

Signs of STEACS in LBBB: Sgarbossa
Consequences of myocardial ischemia: cell death (apoptosis and necrosis), pump failure (impairment of myocardial contraction and relaxation), arrhythmia, and aortic dissection

Non-ACS Causes of Cardiac Troponin (cTn) Elevation

Stroke
Sepsis
Hypoxia
Pulmonary embolism (PE)

Presentation

Chest pain that may radiate to the left arm, jaw, back, and SOB/dyspnea
Episodes of ischemia in the absence of chest pain, presenting with anginal equivalents
Silent ischemia is more common in specific populations, including diabetics, women, women with heart failure, hypertension, and chronic renal disease/end-stage renal disease

Risk Factors

Non-modifiable: Family history, age, male sex
Modifiable: Smoking, hypertension, diabetes, dyslipidemia, obesity, obstructive sleep apnea
Contributing factors: Sedentary lifestyle, stress, depression
Obstetric history: Placental abruption, stillbirth, hypertensive disorders, gestational diabetes, preterm birth

Differential Diagnosis

Ischemic CV causes: ACS, stable angina, severe aortic stenosis, tachyarrhythmia
Non-CV causes: Gastrointestinal, musculoskeletal, pulmonary, herpes zoster
Non-ischemic CV causes: Aortic dissection, expanding aortic aneurysm, pulmonary embolism, peri/myocarditis

Acute Management of Chest Pain

Early access to a defibrillator prevents sudden cardiac death
Aspirin (300mg) should be given early
12-lead ECG should be taken en route and transmitted to a medical facility
Pre-hospital treatment (including fibrinolysis) should be facilitated
On arrival to the hospital: ECG within 10 minutes, continuous ECG monitoring, IV access, aspirin, pain relief, blood tests, and chest X-ray, oxygen therapy, and SpO2 monitoring

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Description

This quiz covers the concepts of ST-elevation acute coronary syndrome (STEACS) and ST-elevation myocardial infarction (STEMI) in relation to coronary artery occlusion.