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CR - ACS (i) (Umbrella term for 3 categories of acute myocardial ischamia,…

- - - - ST elevation
      - LBBB
      - reciporcal changes (e.g. ST elevation on ant leads, ST depression on post leads)
    - - complete occlusion
      - art relatively normal before (<50% stenosed in 70% of cases)
      - platelet-rich thrombus subsequently forms
  - - - ST depression
      - T wave inversion
  - - - often not described as pain
      - often described as exertional indigestion
- - - - pathological Q waves
        
        result of absence of electrical activity
        
        previous MI
        
        increased depth
      - ST elevation/depression
      - T wave inversion
    - - raised troponin
        
        high sensitivity
        
        low specificity (lots of false +ves)
        
        rises then falls so repeat (not chronically highly)
        
        rises 3-8 hrs after injury, may remain elevated for 2 wks
        
        can provide prognostic info
        
        2 types
        
        i
        
        t (may also be raise in renal disease or poly/dermatomyositis
      - creatinine-kinase muscle-brain fraction (CK-MB)
  - - - restore blood supply ASAP
      - thombolysis in < 30 mins
      - revasc in < 90 mins
  - - - not always described as pain - sometimes more of a discomfort
      - can have gradual onset + fluctuate in intensity
      - exacerbated by exercise
        
        blood supply can't match high demands
        
        changed baseline exercise tolerance
  - - - elderly
      - DM
      - post-op
- - - - thrombosis that partially/fully occludes art
        
        unstable angina
        
        MI
        
        stroke/TIA
        
        critical leg ischaemia
      - chronic ischaemia due to narrow lumen
      - symptoms depend on vasc bed affected