Acute coronary syndrome

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What are the 6 causes of chest pain that you can't miss?
Acute coronary syndrome (ACS)
Aortic dissection
Pulmonary embolism
Tension pneumothorax
Pericardial tamponade
Esophageal rupture
What's the mnemonic for characterizing ischaemic chest pain?
O: onset - tends to be gradual
P: provocation, palliation - worse with exertion
Q: quality - more discomfort than pain
R: radiation - to chest and arms
S: site - tends to not be localized
T: time course - usually lasts 2 to 5 minutes, get worried if it lasts longer
What is the Framingham score of a pt based on?
Age
Sex
Cholesterol
Smoking status
Blood pressure
What are the 9 modifiable risk factors identified by the interheart study?
Cholesterol
Smoking
Psychosocial stressors
Diabetes mellitus
Hypertension
Abdominal obesity
Moderate alcohol intake
Lack of exercise
Lack of veg and fruit intake
In an anterior STEMI, which leads will have chanegs?
V1-6
In an anteroseptal STEMI, which leads will have changes?
V1-3
In an apical/lateral STEMI, which leads will have changes?
V4-6, AVL, I
When do you think about putting on posterior and R ventricular leads?
Evidence of inferior ischaemia
You should think about putting on posterior leads if there is ST depression in the anterior leads because they might be reciprocal changes
Which artery is responsible for an inferior STEMI?
Usually R coronary (80% of the time)
Can be L circumflex
L anterior descending in rare cases
Which artery is responsible for lateral ischaemia?
left circumflex
Which artery is responsible for anterior ischaemia?
left anterior descending
Which leads do you look for a STEMI in if you have ST depression in the inferior leads?
I, AVL
Which leads do you look for a STEMI in if you have ST depression in the anterior leads?
Posterior leads
How long does it take troponin to start rising? When does it peak?
Starts rising after 3 hours
Peaks at 12 hours
Why do we do a creatine kinase (CK)?
To look for re-infarction
Which medications do we give in an acute coronary syndrome?
Chest pain relief: nitrates and morphine if desperate
Beta blockers (metoprolol)
Antiplatelet therapy: aspirin, clopidogrel, IIb/IIIa inhibitor if desperate or if undergoing PCI
Anticoagulant therapy (usually clexane)
High dose statin