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303- Cardio > Angina and acute coronary syndrome > Flashcards

Angina and acute coronary syndrome Flashcards

1
Q

Acute coronary syndrome
- Definition and categories

  • Signs and symptoms
A

Set of signs and symptoms due to cardiac ischaemia.

Categories
- STEMI
- NSTE-ACS= NSTEMI, unstable angina

Signs and symptoms
- Chest pain (crushing, heavy)
- Radiation of pain: arms, jaw, abdomen, back.
- Sweaty and clammy
- SOB
- Atypical: nausea, acid reflux type pain

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2
Q

Risk factors for ACS

A

Smoking

Dyslipidemia

Hypertension

Diabetes

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3
Q

STEMI
- Definition
- Diagnosis

A

ACS characterised by ST elevation on an ECG.

Blood tests show elevated troponin.

> 1 mm in contiguous limb leads
2mm in precordial leads

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4
Q

Non STE ACS

A

Includes NSTEMI and unstable angina

NSTEMI
- No ST elevation on ECG
- May show T wave inversion or ST depression
- Will show troponin elevated

Unstable angina
- ACS symptoms occur at rest, lasts for more than 20 mins.
- No ECG changes or significantly raised troponin

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5
Q

Differentials for ACS

A

GI
- GORD
- Oesophageal rupture

Lung
- Pneumonia
- Pneumothorax
- Asthma attack

Cardiac
- aortic dissection
- Pericarditis/ pericardial effusion

Musculoskeletal
- Costochondritis
- Rib fracture

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6
Q

Differentiating MI from GORD

A

GORD
- Lasts longer
- Worse when laying down
- Relived by antacids/ PPIs
- Triggered by eating

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7
Q

Unstable angina management

A

Antiplatelet
- Prevention of build plaque
- Aspirin + clopidogrel/ ticagrelor
- Or Clopidogrel/ ticgrelor if aspirin not tolerated

Statin
- Atrovastatin/ Rosuvatatin

Beta blocker/ ACEi
- Propanolol/ metoprolol/ atenolol/ bisoprolol/ labetalol
- Perindopril/ ramipril

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8
Q

MI treatment

A

Acutely
- Morphine sulphate
- Oxygen >94%
- GTN
- Antiplatelet (aspirin, ticgrelolr, prasugrel, clopidogrel)

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9
Q

Subendocardial infarct

A

Limited to inner third or half of ventricular wall
- Gives rise to NSTEMI/ Unstable angina

  • Due to generalises reduced perfusion of coronary arteries
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10
Q

Troponin assays
- Advantages
- Disadvantages

A

Adv
- Detects recent MI (within 3 hours if high sensitivity)
-

Disadv
- Specificity
- Other causes: strokes, hyperthyroid, renal disease, Subarachanoid bleed, sepsis, blood cancer, PE

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11
Q

GRACE risk score

A

Score to get risk of mortality in hospital or 6 months post discharge

> 3%= significant risk.

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12
Q

Posterior MI ECG changes

A

Inverted findings for ST elevation as electrical activity is recorded anteirorly

ST depression in V1-3
- ST elevation is deflected

Tall R wave in V1-3
- Sign of deep Q wave

Uptight t wave
- T wave inversion

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13
Q

Other causes of STE

A

Acute pericarditis
- Saddle shaped

Myocarditis

Massive PE (esp V1-2)
- Also T wave inversion

Brugada
- Inherited Na+ channel pathology
- Coved STE

Hyperkalaemia/ Calcaemia

Hypothermia

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14
Q

LVH ECG changes

A

Atypical chest pain

ST depression
T wav inversion
- In anterolateral leads

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15
Q

Treatment of MI
- STEMI and NSTEMI/ unstable angina

A
  1. Antiplatelet
    - 300mg aspirin, then 75 mg maintenance +
    - 600mg clopidogrel, 75 mg maintenance
  2. Anticoagulant
    - fondaparinux (if not undergoing PCI)
  3. Anti-ischaemia
    - Beta-blockers
    - ACEi
    - Nitrates
    - Statins (atorvastatin)
    - Eplenerone if LVEF <40%

STEMI= PCI, thrombolysis

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16
Q

Management of stable angina

A

First line
- Beta blocker/ CCB
Shorting acting nitrate
- GTN for symptomatic relief

GTN
- For before and during episodes of angina
- Can repeat after 5 mins if pain persists
- Call ambulance if 2nd dose does not work

17
Q

Management of stable angina

A

Shorting acting nitrate
- Glyceryl trinitrate

For before and during episodes of angina
- Can repeat after 5 mins if pain persists
- Call ambulance if 2nd dose does not work

18
Q

Secondary prevention options for people with stable angina

A

75mg aspirin OD

ACEi
- If diabetic
- If hypertensive

Start statins (atorvastatin) based on background

19
Q

Assessments required before starting statins

A

Bloods
- Lipid profile: total cholesterol, non‑HDL cholesterol, HDL cholesterol and triglycerides
- HbA1c
- LFT = transaminase level (alanine aminotransferase or aspartate aminotransferase)
- renal function and eGFR
- thyroid‑stimulating hormone.

Smoking status

Alcohol consumption

BP

BMI )

20
Q

Statin therapy is indicated for _______ and involves [insert drug name and dose]

A

Indicated for Qrisk2 score of 10% risk of CVD within 10 years (primary intervention)
- 20mg atorvastatin

21
Q

________mg of [statin] is indicated as secondary prevention post-MI

A

80mg atorvastatin

22
Q

Second-line treatment for stable angina (if beta-blocker/ CCB not tolerated)

A

Long acting nitrate (isosorbide mononitrate)

Ivabradine

Nicorandil

23
Q

Coronary angiogram is indicated in stable angina when…

A

Symptoms are not controlled with optimal medical therapy

24
Q

Indications and types of revascularisation in STEMI

A

When coronary angiogram shows significant stenosis
1. PCI
2. CABG

25
Q

Coronary angiogram and PCI in STEMI

A

Angiogram is carried out if ECG shows STEMI
- PCI is indicated if presented within 12 hours + cardiogenic shock (or continued ischaemia)
- unfractionated heparin+ dual antiplatelet therapy given

26
Q

What medications are given to in STEMI undergoing PCI

A

Unfractionated heparin + dual antiplatelet (aspirin 300mg + ticagrelor 180mg)

27
Q

Thrombolysis is indicated in STEMI when…

A

PCI is not available within 2 hours of presentation.

28
Q

Complications of MI (DREAD)

A

D – Death

R – Rupture of the heart septum or papillary muscles

E – “Edema” (Heart Failure)

A – Arrhythmia and Aneurysm

D – Dressler’s Syndrome

29
Q

Dressler’s syndrome describes…

A

Post-MI inflammatory pericarditis that occurs 2-3 weeks after MI.

30
Q

Dressler’s syndrome is managed with

A

NSAIDs

+/- Prednisolone

Pericardiocentesis for pericardial effusion

31
Q

Types of MI (Types 1-4)

A

Type 1: Traditional MI due to an acute coronary event

Type 2: Ischaemia secondary to increased demand or reduced supply of oxygen (e.g. secondary to severe anaemia, tachycardia or hypotension)

Type 3: Sudden cardiac death or cardiac arrest suggestive of an ischaemic event

Type 4: MI associated with PCI / coronary stunting / CABG

32
Q

______ can be used as an alternate anticoagulant to fondaparinux in ACS with renal impairment

A

Unfractionated heparin

33
Q

Coronary angiography is indicated as follow-up within 72 hours for NSTEMI/ Unstable angina when…

A

Intermediate or higher risk of adverse cardiovascular events
- GRACE score >3%

34
Q

Secondary prevention in MI

A

Dual antiplatelet for up to 12 months
- Aspirin 75mg + ticagrelor
- Aspirin monotherapy lifelong

Beta-blocker
- Atenolol
- Continue indefinitely for reduced LVEF

Statin
- Atorvastatin 80mg

Aldosterone antagonist for heart failure (Eplenerone)

35
Q

Secondary medications for stable angina

A

Long acting nitrates
(isosorbide mononitrate)

Ivabradine

Nicorandil

Ranolazine

303- Cardio (9 decks)

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