Acute coronary syndrome

ACS Includes
Unstable angina Unstable atherosclerotic plaque
STEMI graptures promoting thrombus
N STEMI formation which varying degrees
of luminal impingement
Complete occlusion STEM I
t
Incomplete occlusion NSTEMI troponin M without
ST elevation on MI



Symptoms
Central crushing chest pain 1 Jaw or arm radiation
SOB May present atypically in pts
Nausea with diabetes or the
vomiting elderly
Sweating Delirium I B P Epigastric pain

Immediate invx
Obtain an ECG
STEMI ST segment elevation Va Va if
post STEM 1
Tall T waves ST elevation
New BB
ML
In 20 there is a normal ECG


NSTEMI VA ST depression Non specific changes
T wave inversion Normal

, Obtain a CXR
Assess for cardiomegaly mediastinal

widening
Look for non cardiac causes of chest

pain e.g Pneumothorax pneumonia


Arrange bloods
FBC Cardiac enzymes Troponin T or I
Ute with serial measurement 6 hours apart
Glucose to look for T
Lipids

1 Initial management for all pts
Continuous monitoring ideally in a CCU

Aspirin 300mg t 180mgTicagrelor
Pain relief 5 10mg IV Morphine
Anti emetic e.g 10mg IV Metaclopramide
CTN DONOT give if systolic B P 190

Oxygen If Sp02 95 or SOB

Advanced STEMI treatment
Primary percutaneous coronary intervention
Indicated if symptom onset within 12 hours