1. Chest pain - Angina and ACS Flashcards
(49 cards)
What is angina
Narrowing of coronary arteries, reducing blood flow to myocardium so at times of high demand ie exercise there isn’t enough blood supply to the heart
what are the typical symptoms of angina
Constricting discomfort in the front of the chest, or in neck, shoulders, jaw or arms
Precipitated by physical exertion
Relieved by rest or GTN within about 5 minutes
when would angina be classified as unstable
when the symptoms come on randomly whilst at rest
When investigating angina what is the gold standard investigative procedure
CT coronary angiography
Name some of the baseline investigations when trying to diagnose Angina
- Physical Examination (heart sounds, signs of heart failure, BMI)
- ECG
- FBC (check for anaemia)
- U&Es (prior to ACEi and other meds)
- LFTs (prior to statins)
- Lipid profile
- Thyroid function tests (check for hypo / hyper thyroid)
- HbA1C and fasting glucose (for diabetes)
Name some differential diagnosis of chest pain apart from angina
GORD
musculoskeletal pain
anxiety
when should a patient with angina ring for an ambulance
Take GTN, then repeat after 5 minutes. If there is still pain 5 minutes after the repeat dose – call an ambulance
What are the long term symptomatic relief options for patients with angina
Beta blocker (bisoprolol 5mg once a day) or calcium channel blocker (amlodipine 5mg)
{other options that aren’r t first line are long acting nitrates, ivabradine, nicorandil and ranolazine}
What are the 4 A’s in the secondary prevention of angina
Aspirin ( ie 75mg once daily)
atorvastatin 80mg once daily
ACE inhibitor
already on beta-blocker for symptomatic relief
Name 2 procedural/surgical interventions for people with coronary artery disease
- percutaneous coronary intervention (PCI) with coronary angioplasty by placing catheter in the femoral artery or brachial
- Coronary artery bypass graft (CABG)
A patient with a midline sternotomy scar and great saphenous vein harvesting will have had what procedure (think cardiac)
coronary artery bypass graft (CABG)
A patient with a brachial artery access scar or femoral artery access scar have had what kind of cardiac procedure
percutaneous coronary intervention (PCI)
What is acute coronary syndrome usually a result of
a thrombus from an athersclerotic plaque blocking a coronary artery (made up of mostly platelets)
Which coronary artery becomes the circumflex and left anterior descending artery (LAD)
left coronary artery
which coronary artery branch supplies the R atrium and ventricle as well as the inferior aspect of the left ventricle and the posterior septal area
right coronary artery
which coronary artery branch supplies the left atrium and posterior aspect of the left ventricle
circumflex artery
which coronary artery branch supplies the anterior aspect of the left ventricle and the anterior aspect of the septum
left anterior descending (LAD) artery
name the 3 types of acute coronary syndromes (ACS)
unstable angina
Non-STEMI
STEMI
Making a diagnosis with possible ACS symptoms:
On an ECG if there is ST elevation or new LBBB then what is the diagnosis
STEMI
Making a diagnosis with possible ACS symptoms:
If there is no ST elevation on an ECG what investigation should be performed
Troponin blood test
Making a diagnosis with possible ACS symptoms:
If there are raised troponin levels and/or other ECG changes such as ST depression, T wave inversion or pathological Q waves what should you diagnose
NSTEMI
Making a diagnosis with possible ACS symptoms:
If troponin levels are normal and the ECG does not show pathological changes what could the diagnosis be
unstable angina
or
other causes such as musculoskeletal pain
Symptoms of ACS: what accompanying things are associated with the central, constricting chest pain
nausea and vomiting sweating and clamminess feeling of impending doom SOB palpitations pain radiating to jaw or arms
Symptoms of ACS should continue at rest for more than 20 minutes, what would you consider if they settle
angina
