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Ischemic Heart Disease (Acute Coronary Syndrome (ACS) (If 2/3…
Ischemic Heart Disease
Myocardial Infarction
ST elevation (STEMI)
Sudden complete occlusion of coronary artery (100%)
ECG is key diagnostic technique
ST elevation in 2 or more ECG leads
Non ST elevation (NSTEMI)
Partial or near-complete occlusion of coronary artery.
Central chest pressure/discomfort lasting at least several minutes, accompanied by sweating, dyspneoa, nausea and/or anxiety
ECG is first investigation
ST depression
T inversion
Risk factors
age
Dyslipidaemia
Hx CVD
smoking
Obesity
Diabetes
Management
Antiplatelet
Aspirin 150-300mg as single dose, then 75mg OD
Clopidogrel (P2Y12 receptor inhibitor) 300-600mg as loading dose then 75mg OD
Oxygen is SATS <90%
Glycerol trinitrate 0.3-0.6mg suyblingually every 5 mins (max 3 doses
Beta-blocker
Metoprolol 50-100mg BD OR atenolol 50-100mg OD
Invasive therapy e.g. CABG
Evidence of NSTEMI can be seen in cardiac enzymes elevation (troponin)
Acute Coronary Syndrome (ACS)
NSTEMI
Partial/intermittent occlusion, myocardial damage
Inverted T waves and ST depression, signs of ischaemia
STEMI
Complete occlusion, myocardial damage
ST elevation, Q waves and raised troponin
Unstable angina
Partial/intermittent occlusion, no myocardial damage
If 2/3 characteristics
ECG changes
Cardiac enzyme rise
Chest pain