ACS Flashcards
(31 cards)
what is angina?
discomfort in he chest and surrounding areas (jaw, shoulder, back, arm) caused by myocardial ischaemia. The ischaemia is mostly caused by coronary artery disease
what is the difference between typical and atypical angina?
TYPICAL angina is precipitated by physical exertion and relieved by rest or GTN within about 5 minutes. ATYPICAL angina is of increasing frequency / severity occuring during minimal exertion or at rest
what are the risk factors for developing coronary artery disease?
smoking hypertension dyslipidaemia diabetes age gender
what investigations would you order if you suspected ACS?
ECG cardiac troponins FBC U + E lipid profile glucose CXR (if indicated)
what treatments would you give in the acute management of cardiac chest pain?
M - morphine 5-10mg
O - oxygen therapy if sats below 90% or breathless
N - nitrates - GTN
A - aspirin loading dose 300mg
when should you prescribe dual anti-platelet therapy in pts with cardiac chest pain?
CONFIRMED ACS ONLY
give clopidogrel 300mg or ticagrelor 180mg loading dose (ticag better)
name some alternative causes of raised troponins…
sepsis severe heart failure aortic disection myocarditis PE chronic renal failure
what is the definition of a type 1 MI?
rise / fall in troponins along with 1 of the following:
- sx of acute myocardial ischaemia
- ischaemic ECG changes
- regional wall abnormalities on ECHO
- coronary thrombus on CT angio
what is the definition of a type 2 MI?
rise / fall in troponins along with evidence of imbalance between myocardial supply and demand UNRELATED TO coronary artery atherosclerosis
name some causes of type 2 MI…
coronary artery vasospasm coronary emboli (via PFO) coronary artery disection bradyarhythmias respiratory failure + severe hypoxia LVH sepsis / hypotension / shock severe anaemia
describe the sound of an aortic stenosis murmur…
ejection systolic murmur - high velocity crescendo
describe the sound of a mitral regurgitation murmur…
pan systolic
describe the sound of an aortic regurgitation murmur….
early diastolic
describe the sound of a mitral stenosis murmur…
mid diastolic
heart sound s1 is caused by the closure of which valves?
tricuspid and mitral - indicates start of systole
heart sound s2 is caused by the closure of which valves?
aortic and pulmonary - indicates start of diastole
what is s3 ‘gallop rhythm’?
occurs in diastole when ventricles are filling. indicates LV dilation and hypertrophy, often seen in heart failure
explain the concept of physiological splitting of s2…
inspiration causes the the aortic valve to close slightly before the pulmonary valve
which murmurs are heard loudest during inspiration?
right sided murmurs - inspiration increases intrathoracic pressure, increases venous return to right side of heart
which murmurs are heard loudest during expiration?
left sided murmurs - increase in intrathoracic pressure increases pressure of pulmonary circulation. This forces blood into left atrium
sitting forward exacerbates murmurs in which valve?
aortic - brings valve closer to chest wall
leaning to the left exacerbates murmurs in which valve?
mitral - apex closer to chest wall
where does aortic stenosis murmur radiate?
neck > carotids
where does mitral regurgitation murmur radiate?
axilla
