Aetiologies- Cardiac
- Pulmonary
- Vascular
- Gastric
- Chest wall
6 Big Risk Factors - Modifiable
- Smoking
- HTN
- Diabetes
- Hypercholesterolaemia
- Non-modifiable
Non-ACS causes of Trop rise - Increased release
- Reduced excretion
ST elevation - Alternatives
- > 2 mm in 2 contiguous chest leads
- > 1 mm in 2 contiguous limb leads
MAN (MONA has changed gender) - Morphine
- Mild vasodilator
- Anxiolytic => Reduced sympathetic output => Reduced oxygen demand
- Aspirin
- Nitrate
- Use an infusion rather than sublingual so you can titrate against BP
- Primary effect is venodilation
- Reduces preload and therefore oxygen demand
- Also has small effect on coronary arteries
Reversible causes - Ts and Hs - Hypovolaemia
- Hypoxia
- Hyperkalaemia
- Hypothermia
- Tension pneumothorax
- Tamponade
- Toxins
- Thrombosis
CPR - UNINTERRUPTED CPR is the best thing for mortality reduction
- Supplies around 25% of normal cardiac output
- Restart immediately after shocks (don't check rhythm)
Trop - Can interpret absolute value for the first time at 12 hrs
- Or do baseline and 6 hrs, and look for a rise
- "Official MI" = >100
- Cutoff for admission = >14
Therapeutic hypothermia - Give 2 litres of ice-cold saline
- 8% decrease in BMR for each degree Celcius drop
Notes - ACS is defined by PLAQUE RUPTURE
- 10 % of unstable angina presentations progress to MI
- "You're not dead until you're warm and dead"
- Pain severity score is useful to monitor CHANGE
- All defibrillators these days are biphasic
- Non-shockable rhythms
- Risk scores in ACS
- GRACE (recommended by NICE)
- TIMI
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