Angina, myocardial ischaemia + infarction

Question 1

what is angina due to and what does it present as

Answer 1

myocardial ischaemia, central chest tightness radiates to one or both arms, jaw, neck, teeth

Question 2

cause of angina

Answer 2

atheroma (rare- anaemia, AS, tachyarrythmia, HCM, arteritis)

Question 3

associated symptoms of angina

Answer 3

dyspnoea, nausea, sweatiness, faintness

Question 4

types of angina

Answer 4

stable( induced by effort relieved by rest), unstable (increasing freq/severity, min exertion), Decubitus (lying flat), variant/Prinzmetals (coronary artery spasm)

Question 5

tests for angina

Answer 5

ECG can show ST depression, flat/inverted T wave

Question 6

what drugs can be used to treat angina

Answer 6

aspirin, B blockers, nitrates (GTN spray), long acting calcium antagonists (amlodipine, diltiazem), K channel activator

Question 7

what is PTCA (for angina)

Answer 7

percutaneous transluminal coronary angioplasty- balloon dilatation of stenotic vessels.

Question 8

complications of PTCA

Answer 8

restenosis, emergency CABG

Question 9

What is ACS

Answer 9

acute coronary syndrome- unstable angina, evolving MI

Question 10

what is the pathophysiology of ACS

Answer 10

plaque rupture, thrombosis, inflammation. rarely emboli or spasm in normal coronary arteries

Question 11

what is acute MI defined as

Answer 11

ACS with ST elevation or new onset LBBB. increase then decrease in biomarkers, pathological Q waves, loss of myocardium on imaging

Question 12

risk factors of ACS

Answer 12

age, male, Fhx, smoking, hypertension, DM, hyperlipidaemia, obesity

Question 13

symptoms ACS

Answer 13

acute central chest pain lasting >20 mins, nausea, sweatiness, dyspnoea, palps, syncope, Pulm oedema

Question 14

signs ACS

Answer 14

anxiety, pallor, sweaty, tachy or bradyc, hyper/hypotension, 4th heart sound. signs of heart failure: incr JVP, 3rd heart sound, basal creps, pansystolic murmur.

Question 15

tests for ACS: ECG

Answer 15

tall T wave, ST elevation, new onset LBBB, T wave inversion, pathological Q waves

Question 16

tests for ACS: CXR

Answer 16

cardiomegaly, pulm oedema, widened mediastinum

Question 17

tests for ACS: blood and cardiac enzymes.

Answer 17

FBC, U&Es, glucose, lipids. cardiac troponin incr 3-12hr from onset pain; peak 24-48hr, decr to baseline 5-14 days. creatinine kinase- CK-MM, CK-MB, CK-BB. Myoglobin- highly sensitive not specific

Question 18

differential diagnosis of ACS

Answer 18

angina, pericarditis, myocarditis, aortic dissection, PE, reflux

Question 19

management ACS: emergency

Answer 19

aspirin 300mg chewed, GTN sublingual. analgesia and metoclopramide. in hosp: O2, IVI, morphine, aspirin

Question 20

management ACS: with ST elevation

Answer 20

primary angioplasty/thrombolysis; B blocker (atenolol 5mg); ACE-I (lisinopril 2.5mg); clopidogrel 300mg loading followed by 75mg/day for 30 days

Question 21

management ACS: without ST elevation

Answer 21

B blocker; antithrombitic/LMWH; assess risk GRACE score; high risk- GPIIb/IIIa, clopidogrel; low risk- clopidogrel.

Question 22

management ACS: subsequent management

Answer 22

bed rest; daily exam; prophylaxis against thromboembolism; aspirin; B blockers; ACE-I; statin

Question 23

complications of MI

Answer 23

cardiac arrest, cardiogenic shock, unstable angina, brady or heart block, tacyarrhythmias, RVF, pericarditis, DVT/PE, systemic embolism, cardiac tamponade, MR, ventricular septal defect, Dresslers, LV aneurysm

Question 24

what is Dresslers syndrome

Answer 24

2-5 weeks post MI. pleuritic chest pain, low grade fever, pericarditis, pericardial effusion.

Question 25

how to treat Dresslers

Answer 25

treat with aspirin, NSAIDS, steroids

Question 26

if suspect MI how do you treat this

Answer 26

MONA- Morphine, O2, Nitric oxide (GTN), aspirin (300mg chew)