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CVS > acute coronary syndromes > Flashcards

acute coronary syndromes Flashcards

1
Q

what are the 3 different types of acute coronary syndromes?

A

SUN

stemi
unstable angina
non-stemi

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2
Q

what is NSTEMI?

what is STEMI?

A

NSTEMI = NON ST ELEVATION myocardial infarction

stemi = st elevation myocardial infarction

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3
Q

what biochemical cardiac marker is measured when a diagnosis of acute coronary syndrome is being made?

A

troponin

as it is released when heart muscles are damaged

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4
Q

what is the biological cause of acute coronary syndrome?

A

plaque in arteries causes partial or complete obstruction of artery. causes lack of oxygen and blood supply causing chest pain/ischaemia [angina] which is first sign.

if there is complete obstruction of arteries, lack of oxygen to the heart results in muscle death then myocardial infarction

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5
Q

which of STEMI and NSTEMI is serious?

A

S- serious stemi

nstemi - not serious

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6
Q

which out of the STEMI and NSTEMI results in complete obstruction of heart arteries and heart muscle necrosis?

A

stemi =complete obstruction of arteries

nstemi=partial obstruction

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7
Q

what is angina? how can it come about? when do symptoms stop?

A

not enough blood going through arteries.

caused by exercise/stress

symptoms stop within few mins of resting

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8
Q

what are the symptoms of angina?

A

shortness of breath
sweating
dizziness
chest pain/tightness/SHARP STABBING PAIN [angina]
stabbing pain that spreads to left arm/jaw/neck/back
nausea
fatigue

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9
Q

which is more dangerous: unstable or stable angina?

A

unstable angina = unpredictable. more dangerous

stable = predictable.

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10
Q

what are the differences between stable and unstable angina?

A

stable = symptoms occur during exercise/stress

unstable= symptoms occur whilst resting/ symptoms last longer and are more severe

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11
Q

what drugs are used for UNSTABLE angina / myocardial infarction?

A

C OSAMA BIN [when you c osama bin, you have a heart attack]

clopidogrel
oxygen
statin
ACE inhibitor
metoclopramide
aspirin
beta blockers
LV heparin, morphine, diamorphine 
nitrates
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12
Q

what is the initial management of acute coronary syndrome?

A
  • pain relief should be given with glyceryl trinitrate [sublingual/buccal] ASAP
  • iv opioids eg morphine
  • a 300mg loading dose of aspirin asap
  • oxygen of needed
  • insulin for those with hyperglycaemia [>11mmol/L]

mona [morphine, oxygen, nitrates [GTN], aspirin]

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13
Q

what is the management of STEMI?

A
  • aspirin 300mg
  • plus a second antiplatelet: clopidogrel/ticagrelor/prasugrel
  • unfractionated heparin for pt with renal impairment
  • antithrombin agent for pt with fibrinolysis
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14
Q

what is the management of UNSTABLE ANGINA or NSTEMI?

A

similar to STEMI

  • aspirin 300mg
  • second antiplatelet: clopidogrel/prasugrel/ticagrelor
  • unfractionated heparin for pt with renal impairment
  • antithrombin treatment with fondaparinux
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15
Q

what is the management of STABLE angina that is SHORT TERM?

A

sublingual glyceryl trinitrate taken before an activity that is known to bring up an attack eg exercise

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16
Q

what is the of long term management of STABLE angina?

A
  • beta blocker 1st line for prevention of chest pain
  • if beta blockers are not tolerated, give rate limiting calcium channel blockers [verapamil or diltiazem]
  • can give beta blocker and CCB both together if beta blocker alone is not enough to control
  • ALL pt must be given low dose aspirin and a statin
  • diabetic pt may be given ACE inhibitor
17
Q

what drugs can be ADDED for long term management of STABLE angina if both beta blockers and ccb are not tolerated?

A

add either ivabradine, nicorandil or ranolazine

18
Q

what should be given to patients who have once had NSTEMI, stable and unstable angina as PREVENTION of cardiovascular events?

A
  • give lifestyle advice to reduce risk

- give aspirin, statin, ace inhibitor and beta blockers

19
Q

what drug should be given to pt with STABLE angina and diabetes?

A

ACE inhibitors

20
Q

in patients with unstable angina or NSTEMI, dual antiplatelet is recommended. which drugs should be used and for how long?

A

aspirin and clopidogrel for 12 months

[prasugrel or ticagrelor can be used if clopidogrel intolerant]

21
Q

nitrates [eg GTN] are beneficial in angina. how do they work?

A

work as vasodilators: dilate blood vessels to increase more blood and oxygen to the heart

22
Q

what are the 3 main forms of sublingual GTN?

A

tablets
spray
patches

23
Q

what are the main side effects of nitrates [eg GTN]?

A

postural hypotension
headache
flushing

24
Q

how long do the effects of GTN last for?

A

20-30mins

25
Q

how often in a week should the GTN spray be used for the GP to request long term prophylaxis instead?

A

more than twice a week

26
Q

what is the dose of GTN tablets for PROPHYLAXIS of angina?

A

take 1 tablet before an activity that will likely cause an angina attack

27
Q

what is the dose of GTN tablets for TREATMENT of angina?

A

1 tablet to be taken at 5 min intervals. if symptoms not resolved after 3 doses then medical attention needs to be sought

28
Q

what is the dose of GTN SPRAY for TREATMENT AND PROPHYLAXIS of angina?

A

1 or 2 sprays under the tognue

29
Q

what is the dose of GTN transdermal PATCH for TREATMENT of angina?

A

one patch to be changed every 24 hours

30
Q

what are the 3 drugs in the nitrates class?

A

glyceryl trinitrate
isosorbide monotritrate
isosorbide dinitrate

31
Q

how many times a day is MR isosorbide mononitrate meant to be taken?
how many a times a day is MR isosorbide dinitrate meant to be taken?

A

mono = once daily

di = twice daily

32
Q

what is IV glyceryl trinitrate and iV isosorbide dinitrate used for?

A

severe symptoms or when sublingual is ineffective

33
Q

what is the main caution of nitrates?

A

patients develop tolerance

34
Q

what are the different ways you can prevent patients developing a tolerance to nitrates? [3]

A
  • take isosorbide mononitrate MR as its once daily and has lower tolerance risk
  • for twice daily tablets take the second dose after 6-8 hours instead of 12
  • leave patches off for 8-12 hours [usually at bedtime]
35
Q

what are the 3 strengths of GTN tablets?

A

300, 500 and 600mcg

36
Q

what is the storage requirements for sublingual GTN tablets? [4]

A

supplied in glass containers
no more than 100 tabs in each container
enclosed with foil line cap
no cotton wool

37
Q

when should you discard GTN tablets after opening?

what abt GTN rectal ointment?

A

both after 8 weeks

38
Q

how should a patient take GTN tablets?

A

sitting down to reduce risk of postural hypotension risk

CVS (7 decks)

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