Acute Coronary Syndromes

Vocabulary flashcards for Acute Coronary Syndromes lecture notes.

Cardiovascular disease (CVD)

Represents the leading cause of death in the United States, including coronary heart disease (CHD), heart failure, hypertension, and stroke.

Endothelium

The inner, single-cell layer of the artery that plays a role in vasomotion, hemostasis, and thrombosis formation.

Artery Lumen

Channel for blood flow within the artery.

Normal Artery Intima

Underneath the endothelial basement membrane where lesions of atherosclerosis form.

Adventitia

The outermost layer of the arterial wall.

Media

Smooth muscle cells of the arterial wall.

Normal Heart Function

Requires ATP for normal contraction and relaxation of the cardiac myocytes.

Coronary blood flow

Averages 60 to 90 mL · min−1 · 100 g−1 of myocardium at rest and may increase five- to sixfold during exercise.

Myocardial oxygen uptake

Is approximately 8 to 10 mL per 100 g of tissue per minute at rest and may increase 200%-300% during intense exercise.

Ischemic Cascade

Left ventricle stiffening, impaired systolic emptying, EKG abnormalities, and angina pectoralis.

Acute Coronary Syndromes Composition

Unstable angina pectoris, acute myocardial infarction (MI), and sudden cardiac death due to myocardial ischemia.

Most Common Underlying Mechanism of Acute Coronary Syndromes

Atherosclerotic plaque erosion, rupture, or other plaque disruption; vasospasm, microvascular disease, myocarditis, cocaine use, or stress cardiomyopathy.

Acute Coronary Syndrome (ACS) Presentation

Symptoms of ischemia and EKG signs such as ST to T wave abnormalities.

Acute Myocardial Infarction

Necrosis (death) of cardiac myocytes resulting from prolonged ischemia.

Key event in Acute Myocardial Infarction

Disruption of the myocyte membrane.

Clinical Assessment for Acute Coronary Syndrome

History of symptoms, physical examination, electrocardiogram, chest radiograph, and laboratory results.

Diagnosis of Acute Myocardial Infarction

Elevated cardiac necrosis biomarkers plus symptoms of ischemia, ECG evidence, new Q waves, or imaging evidence.

Cardiac Troponin (cTn)

Preferred biomarker for diagnosing acute myocardial infarction, elevation 2-3 hours after onset, remains elevated 1-2 weeks.

Causes of Myocardial Ischemia

Not enough blood, atherosclerosis, vasospasm, thrombosis, or embolism.

STEMI

ST-segment elevation of at least 1 mV in two contiguous leads or new left bundle branch block.

NSTEMI

ST-segment depression or T wave inversion persisting at least 24 h.

Diagnosis of Unstable Angina

Prolonged rest angina, new-onset angina, and accelerated angina.

Management of Acute Coronary Syndromes

Anti-ischemic therapy, dual antiplatelet therapy, anticoagulants, pain relief, and reperfusion therapy.

Early invasive strategy for Non-ST-Segment Elevation Myocardial Infarction/Unstable Angina Pectoris

Percutaneous coronary intervention most common.

Reperfusion strategies for ST-Segment Elevation Myocardial Infarction

Thrombolysis or primary PCI.

Cause of Right Ventricular Myocardial Infarction

Occlusion of the proximal right coronary artery.

Antiplatelet Medication (aspirin, clopidogrel)

Blocks platelet aggregation and improves survival, but increases bleeding.

β-blocker (metoprolol)

Reduces heart rate and blood pressure, improves survival, and has antiarrhythmic properties, but can cause fatigue, hypotension, and bradycardia.

ACE inhibitor (lisinopril)

Reduces blood pressure and improves survival, but may cause cough or hypotension.

Stress Testing

Used to evaluate symptoms and potential myocardial ischemia and determine if medical therapy was effective and assess future risk.

Inpatient cardiac rehabilitation

Hospitalizations 2-3 days if no complications.

Early outpatient cardiac rehabilitation

Recommended for all patients with CAD by AHA, ACC, and AACCVPR, can begin 1-2 weeks after hospital dismissal, ideal for secondary prevention goals, and includes counseling.

HIIT for Cardiac Patients

May be more effective than MICT, increasing CV fitness, VO2peak, endothelial function, left ventricular function, and mitochondrial density/function, with a similar adverse incidence rate.

Safety of exercise training for coronary patients

Supervised exercise training has been demonstrated to be safe for patients with cardiovascular disease.

Acute coronary syndromes

Atherosclerotic plaque development, disruption, and thrombus formation, leading to myocardial ischemia and potential necrosis.

Unstable angina pectoris

Transient coronary artery occlusion with spontaneous clot dissolution and no demonstrable myocardial necrosis.

Cardiac rehabilitation

Results in impressive benefits for patients, including reduced mortality.