acute coronary syndrome
CC1
Sorry this page is so bare. I thought it would be 'too obvious' or something.
| Etiology | Artherosclerotic plaques most often. Myocarditis, Takotsubo, supply/demand mismatch (the so-called 'type 2 MI') |
| Epidemiology | SCAD - more common in postpartum and pregnant patients |
| Clinical presentation | Chest pain at rest; signs of cardiogenic shock |
| Pathogenesis | |
| Diagnostic investigations | - STEMI = ST ↑ >2mm in ant leads or >1mm in 2 consec inf leads; pathological Q waves, LBBB. See OMI - Echo: new regional wall movement abnormalities - Troponin (long t½, can persist for ~1/52) |
| Management | - dual antiplatelet - aspirin 300mg immediately, then clopi (already anticoagulated) or prasugrel (not on anticoag) - PPCI - If PPCI cannot be delivered within 120 min, and within 12h of onset, fibrinolysis Complications: Pericarditis; free wall rupture |
| Prevention | - stop smoking - diet - "Mediterranean-style diet" - regular physical activity - "20-30 mins a day to the point of slight breathlessness" - maintain healthy weight |
clinical presentation can be misleading
| History | Likelihood Ratio |
|---|---|
| Radiation to right arm/shoulder | 4.7 |
| Radiation to both arm/shoulder | 4.1 |
| Associated with exertion | 2.4 |
| Radiation to left arm | 2.3 |
| Associated with diaphoresis | 2 |
| Associated with nausea/vomiting | 1.9 |
| Worse than previous angina | 1.8 |
| Described as pressure | 1.3 |
see NSTEMI, STEMI equivalents, or STEMI
sources/links
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)02391-6/fulltext
https://jamanetwork.com/journals/jama/article-abstract/2789023
https://www.nice.org.uk/guidance/ng185
https://derangedphysiology.com/main/required-reading/cardiovascular-intensive-care/Chapter-001/essential-reading-cardiovascular-intensive-care → for ICU type general overview