ACS Teaching Session

• 56F presents to ED with L sided chest pain. What are the differentials?

  Cardiac/vascular

  • Acute Coronary Syndrome
  • Angina pectoris
  • Aortic dissection
  • Pericarditis
  • Arrhythmia

  GI

  • Peptic ulcer disease
  • GORD
  • Oesophagitis
  • Oesophageal perforation
  • Pancreatitis

  Pulmonary

  • PE
  • Lower resp tract infection (LRTI)
  • Pneumothorax
  • Pneumonia
  • Lung cancer

  Other

  • Herpes Zoster
  • Costochondritis
  • Rib fracture
  • Anxiety/panic attack
• Stable angina vs ACS

  SA

  • precipitated by stress or exertion
  • Lasts < 20 mins
  • Relieved by GTN or rest

  ACS

  • at rest or minimal exertion
  • Lasts > 20 mins
  • often accompanied by other symptoms
  • poor GTN relief
• What are the different types of MI based on pathophys?

  Type 1 - spontaneous MI caused by ischaemia due to primary coronary event

  Type 2 - ischaemia due to increased O2 demand or decreased supply (hypoperfusion)

  Type 3 - MI but death occurs before bloods can be obtained for biochemical evidence

  Type 4 - related to PCI or stent thrombosis

  Type 5 - associated with coronary artery bypass grafting
• What are the different types of MI based on symptoms?

  Silent

  • MI w/o anginal symptoms (pain, nausea, SOB)
  • RFs -> heavy smoking. FHx of heart disease, diabetes, obesity

  Symptomatic
• What are the different types of MI based on ECG?

  STEMI

  NSTEMI
• What is troponin?

  Protein components involved in contractile mechanism of striated muscle

  Controls the Ca+2 mediated interaction of actin & myosin
• What are the types of troponin?

  Troponin I

  Troponin T

  Troponin C
• Fill in the blanks

  A) Inferior

  B) Anterior

  C) Lateral

  D) Lateral

  E) Lateral

  
• What is the driving advice following an MI?


  No need to inform DVLA

  Should stop driving for...

  • 1 week -> if had angioplasty & was successful
  • 4 weeks -> have angioplasty & wasn't successful
  • 4 weeks -> had MI but didn't have angioplasty
• Any features of ACS should be referred directly to hospital.