acute coronary syndromes

Question 1

what happens when a b.v narrows?

Answer 1

inadequate O2 delivery for tissue needs
cramp in affected tissue/muscle
no residual deficit at first

Question 2

what happens when a b.v is occluded?

Answer 2

no O2 delivery - tissue death
severe pain
loss of function of muscle

Question 3

what are acute coronary syndromes?

Answer 3

acute ischaemic events affecting the heart

Question 4

describe stable angina

Answer 4

increased demand due to atherosclerotic plaque
vessel unable to dilate enough for adequate blood flow
prompted by exercise
normal ECG
normal troponins

Question 5

describe unstable angina

Answer 5

plaque ruptures and thrombus forms around ruptured plaque causing partial occlusion of vessel
occurs at rest
normal troponins

Question 6

describe NSTEMI

Answer 6

plaque rupture thrombus formation causes partial occlusion to vessel that results in injury and infarct to subendocardial myocardium
elevated troponins

Question 7

describe STEMI

Answer 7

ST elevation
complete occlusion of b.v lumen resulting in transmural injury and infarct to the myocardium
elevated troponin

Question 8

how is ACS diagnosed?

Answer 8

history
ECG findings
biomarkers -troponin

Question 9

what are the symptoms of stable angina?

Answer 9

no pain at rest
pain w/ certain level of exertion
-worse w/ cold weather/emotion
pain relieved by rest
px lives w/i limits of tolerance
gradual deterioration

Question 10

what is hyperdynamic circulation?

Answer 10

anaemia
hyperthyroidism
hypovolaemia

Question 11

what investigations are used for angina?

Answer 11

ECG
-rest/exercise
eliminate other disease
angiography
echocardiography
isotope studies

Question 12

what is an exercise ECG?

Answer 12

tests ischaemia of the heart in real time

allows changes to be seen and stopped at reversible stage

Question 13

how is angina treated?

Answer 13

reduce O2 demands of heart
-reduce afterload (BP)
-reduce preload
-correct mechanical issues
increase O2 delivery to tissues
-dilate blocked/narrowed vessels - angioplasty
-bypass blocked/narrowed vessels
CABG

Question 14

what are the non-drug therapies for angina?

Answer 14

explanation of illness
-live w/i limitations
-adequate for someone with limited activity/mobility
modify risk factors
-stop smoking
-exercise program
-improve diet/ control cholesterol

Question 15

what is the drug therapy available for angina?

Answer 15

to reduce MI risk -aspirin
hypertension
-diuretics, Ca channel antagonists
-ace inhibitors, B blockers
reduce heart filling pressure/ dilate coronary vessels
-nitrates 
-short/long actine
emergency GTN spray
-short shelf life
-reduces preload
-sublingual

Question 16

what is the surgical therapy for angina?

Answer 16

CABG
-benefit not always obtained
-major surgery
-10 year benefit
angioplasty & stenting
-lower risk but lower benefit
-risk of vessel rupture during procedure
-percutaneous intervention (PCI)

Question 17

what is peripheral vascular disease?

Answer 17

angina of the tissues
-usually lower limb
-artheroma in femoral/popliteal vessels
claudication pain in limb on exercise
-claudication distance
-pain relieved with rest
managed same as angina

Question 18

what are some consequences of PVD?

Answer 18

limitation of function
poor wound healing
may lead to tissue necrosis & gangrene
aggravated by CV risk factors

Question 19

how does ischaemia progress to infaction?

Answer 19

atheroma in vessels
-ulcerated plaques with platelet aggregates
-thrombosis on the surface
thrombosis can enlarge rapidly to block vessel
plaque surface/platelets detach
-travel downstream and block vessels
-no blood flow to that area - infarction

Question 20

where does infarction occur in:
heart
limb
brain

Answer 20

coronary artery
femoral & popliteal arteries
carotid arteries

Question 21

what is a myocardial infarction?

Answer 21

result of blocked left anterior descending coronary artery

Question 22

what is the strategy for infarction?

Answer 22

reduce tissue loss from necrosis
-open blood flow to ischaemic tissue
-thrombolysis
-angioplasty
bypass obstruction
-CABG, fem/pop bypass

Question 23

how to prevent a further infarction?

Answer 23

risk factor management

aspirin

Question 24

what is a stroke?

Answer 24

short duration
transient ischaemic attack
deficit variable
-loss of function
-depends on brain region involved
-usually some recovery in time

Question 25

what are the signs & symptoms of myocardial infarction?

Answer 25

pain, nausea, sweaty
“going to die”
silent MI possible

Question 26

what are the consequences of MI?

Answer 26

death

functional limitation from reduced cardiac muscle action

Question 27

how is an MI diagnosed?

Answer 27

history
ECG findings
-STEMI/NSTEMI
biomarkers
-troponin

Question 28

what is the primary care for MI?

Answer 28

aim to get px to hospital alive
analgesia, aspirin & reassurance
BLS is needed
-cardiac arrest situation

Question 29

what is the hospital tx for MI?

Answer 29

up to 3 hours primary PCI
-acute angioplasty and stenting
up to 6 hours thrombolysis
medical tx to reduce tissue damage
-improve penumbra
prevent recurrence/complications
-secondary prevention

Question 30

describe angioplasty & stent

Answer 30

catheter inserted through artery
-femoral or radial
moved to site of blockage under x-ray
balloon inflated to open blockage
metal stent clicks rigid to hold vessel open and allow blood flow

Question 31

describe thrombolysis

Answer 31

best option for delayed admission
best option of no access to angioplasty & stent
contraindications
-injury/surgery/IM injections -recent blood clots would be dissolved
-severe hypertension, active PUD - would exacerbate active bleeding
-diabetic eye disease. liver disease, pregnancy

Question 32

what are the complications of MI?

Answer 32

death
post MI arrhythmias
-1st few hours
-worse if reperfusion
-can be fatal
heart failure
ventricular hypofunction & mural thrombosis
DVT & pulmonary embolsim
-esp. during tx

Question 33

how is another MI prevented?

Answer 33

risk modification & aspirin
B blocker
ACE inhibitor

Question 34

what complications need treated?

Answer 34

heart failure
arrhythmias
psychological distress