Acute Coronary Syndrome Flashcards
What are the types of acute coronary syndrome?
Nontransmural MI, unstable angina pectoris (risk for transmural MI), stable AP
What is crescendo angina?
A more severe, prolonged and frequent form of unstable angina.
What forms of angina are classified as unstable AP?
Crescendo angina, new onset AP (
Definition of Acute Coronary Syndrome (ACS)
Change in pattern of symptoms, new onset AP, accelerated angina, angina at rest, acute MI
What is a stable plaque?
Thick covering with smooth muscle cells and collagen elastic fibers.
How does an unstable plaque vary from a stable one?
Bigger lipid core, thin shoulders that can rupture.
What happens with plaque fissure or erosion resulting in thrombosis?
Unstable angina that may lead to AMI.
What are the elements of activation of unstable plaque?
Platelet activation, vasoconstriction, endothelial dysfunction, thrombosis, inflammation (may be cause)
How does concentration of IL4 and interferon relate to stability of angina?
Higher concentration means more inflammation so unstable angina.
What happens during thrombosis that contributes to unstable angina?
Increased fibrin related antigens and D-dimer, increased tPA, hypercoaguable state. Release of thrombotic factors. Can lead to total occlusion of artery–>STeMI
Clinical presentation of unstable angina
More intense pain for longer and at rest. May have S4 and transient mitral regurgitation
What does the ECG show in unstable angina?
Transient ST depression/elevation, T inversion
What do the labs show in unstable angina?
Raised troponin and CRP
Who is high risk for unstable angina?
Age >65, known CAD, >3 CAD risk factors for CAD, prior aspirin use, >2 episodes of chest pain in 24h, ST deviation >0.5mV, elevated troponin/CKMB.
What are risk factors for CAD?
FH, high cholesterol, HTN, DM, smoking
