The heart.

Jametlene Reskp

Haha, I have really got to work on my consistency in blog posting!
Anyway, I have been struggling to study recently, trying to maximise my free time, which is the entire day!
You see, I tend to get caught up in mobile games and Youtube videos, I do tell myself that I am just taking a break but I never really stop once I start!
It's like studying are the breaks I take in between games and video watching! Ughhh!
So I've just read about unstable angina and NSTEMI.
We all do have some knowledge about heart attacks, don't we?
The heart attacks we commonly talk about is referred to as STEMI ( ST-segment Elevation Myocardial Infarction).
Usually once a patient with chest pain comes, the first thing we do is we get the ECG done, because if he/she were experiencing a heart attack, we will get a very peculiar finding which is pretty much diagnostic- the ST-segment will be elevated.

Back to the topic, then what are unstable angina and NSTEMI?
These 3 entities fall under a spectrum called Acute Coronary Syndrome.
Basically, the characteristics of this ACS are:

1. Chest pain - which is retrosternal, radiating to limbs/jaw etc
2. ECG changes - especially changes in the ST segment
3. Cardiac biomarkers release 

So what differentiates unstable angina from the usual angina/stable angina? 

UA = 

Exertional angina of recent onset (within 6 weeks) of class III severity

Angina at rest/minimal exertion, generally lasting for >20minutes

Angina of worsening severity - increased duration of pain, pain occurring on less exertion, increasing requirement of nitrates. 

Basically, it is worse and more frequent angina. 

And what differences do UA and NSTEMI have? 

In NSTEMI, there has been sustained myocardial damage, thus there will be an elevation in cardiac biomarkers, which is not seen in UA. 

To manage such cases, the patients have to be hospitalised first. 

Treatment given stat:

1. Crushed aspirin
2. GTN
3. Clopidogrel

Treatment subsequently given are:

1. Aspirin
2. Anticoagulants - LMW Heparin - enoxaparin sodium/fondaparinux sodium
3. Other antiplatelets - ticlopidine, ticagrelor, prasugrel
4. Oxygen administration
5. Statins to lower blood lipid levels
6. Other cardiovascular drugs as indicated - ACEis, ARBs, beta-blockers etc. 

On a lighter note, consume more tomatoes because they're good for the heart! 

Their cut section does look like a dual-chambered heart, don't you think? 

Till then!