Summary
Acute coronary syndrome summary
- Module
- Medicine
- Institution
- The University Of Manchester (UOM)
Summary of acute coronary syndromes including STEMI, NSTEMI and unstable angina. Notes on symptoms, investigations and management.
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ACSSuspect ACS when: chest pain more than 15 minutes, N+V, sweating, breathlessness, haemodynamic
instability, pain occurs without exertion. DO NOT use response to GTN to confirm or exclude diagnosis.
Normal ECG does not exclude ACS.
Initial management
M: morphine (+IV metoclopramide/cyclizine)
O: oxygen if sats below 94%
N: GTN
A: aspirin 300 mg then 75 mg OD
C: clopidogrel 300 mg then 75 mg OD
All ACS can be given PCI if haemodynamically unstable
Plus, start: secondary prevention atorvastatin 80 mg ON, beta blocker bisoprolol 2.5 mg OD, LMWH
fondaparinux (can also start ACEI)
Long term management
Beta blocker for 12 months – reduces myocardial demand
ACEI – prevents cardiac remodelling
GTN spray PRN
Aspirin (lifelong), clopidogrel (12 months), statin
BP control, lifestyle modifications (Mediterranean diet, exercise, smoking cessation)
Symptoms
Central crushing chest pain
Occurs several times a day with increasing severity
Can occur at rest (unstable angina)
Radiation to jaw, arm or neck
Dyspnoea and tachycardia
Nausea and sweating
Unstable angina
NO ST elevation on ECG with negative cardiac markers
Risk factors: female, older age > 50, family history, personal history of CAD, hypertension, diabetes,
hyperlipidaemia, obesity, smoking
Differentials
o Stable angina – pain occurs only by exertion and is relieved by GTN or rest
o STEMI – ECG ST elevation
o NSTEMI – raised cardiac markers
Diagnostic investigation is CT coronary angiography
NSTEMI
Acute ischaemic event. NO ST elevation on ECG with positive cardiac markers. Men and women present
differently. Men typical chest pain lasting several minutes. Women middle/upper back pain with dyspnoea.
Risk factors: increasing age, previous CAD, smoking, diabetes, obesity, dyslipidaemia
Investigations
o ECG
o Cardiac biomarkers
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