Introduction
Acute Coronary Syndromes (ACS)
This is basically an umbrella term for:
- STEMI – ST elevation MI
- NSTEMI – non-ST elevation MI
- Unstable angina
They are grouped together because – they all have a common mechanism –rupture or erosion of the fibrous cap of a coronary artery plaque.
Imagine it like a spectrum – with unstable
angina at one end, and STEMI at the other – NSTEMI is in the middle.
Epidemiology
- It is the most common cause of death in the UK
- 50% of deaths occur within 2 hours of onset of symptoms
- Incidence of 300 000 cases per year
- More than 1.4m people in the UK suffer from angina – this also has incidence of approximately 2%
- CAD accounts for about 3% of admission to UK hospitals each year
Aetiology
Non-modifiable
- Age
- Gender (male)
- FH of IHD – only if symptoms present before the age of 55
Modifiable
Controversial
- Stress
- Type ‘A’ personality
- LVH – left ventricular hypertrophy
- Cocaine use
- ↑ fibrinogen
Symptoms
- Pain! Can radiate down the inside of the arm, and into the neck and jaw and can last up to a couple of hours. May also radiate to the epigastrium or back
- Distress, also sometimes a ‘feeling of impending doom’
- Breathlessness – indeed in many cases this may be the only symptom – many MI’s actually pass unrecognised – particularly in diabetic patients – ‘silent MI’
- Syncope – fainting – if this occurs, then it will be a result of severe arrhythmia, or severe hypotension.
- Sweating
- Tachycardia
- Vomiting and sinus bradycardia– this may occur as a result of excessive vagal stimulation, which is most common in inferior MI
- Nausea and vomiting may also be aggravated by opiates given for pain relief
- Sudden death – this usually occurs from ventricular fibrillation or asystole. Most of these deaths occur within the first hour.
- If the patient survives the first hour, then the liability of serious arrhythmias remains, but diminishes with each subsequent hour. So, patients have to be educated to
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