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Myocardial Infarction and Acute Coronary Syndromes (ACS)

In This Article

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.
 
For more information on the pathology, and a general overview of atherosclerotic disease, see the Atherosclerosis article

 

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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
 
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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
 
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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