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BDS2 BAMS Cardiovascular medicine > Acute coronary syndromes > Flashcards

Acute coronary syndromes Flashcards

1
Q

What are the two pathological processes in acute coronary syndromes? Describe them both

A

Blood vessel narrowing

  • inadequate oxygen delivery for tissue needs
  • ‘cramp’ in affected tissue/muscle
  • no residual deficit at first

Blood vessel occlusion

  • no oxygen delivery
  • more severe pain
  • loss of function of tissue
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2
Q

What is angina

A

reversible ischaemia of heart muscle (narrowing of one or more coronary arteries)

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3
Q

What is myocardial infarction and stroke (CVA)

A

tissue death as a consequence of blocking in arteries

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4
Q

ACS diagnosis: What ECG segment might change in a myocardial infarction

A

ST

if changes: STEMI
if doesn’t change: NSTEMI

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5
Q

What biomarker is used for ACS diagnosis

A

troponin

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6
Q

What is atherosclerosis

A

a disease in which the inside of an artery narrows due to the build up of plaque

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7
Q

What is a characteristic of classical angina

A

it gets worse with exercise

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8
Q

What is a characteristic of unstable angina

A

painful symptoms at rest

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9
Q

What is the common pain to all angina types

A

‘central crushing chest pain’

radiation to arm, back, jaw possible

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10
Q

What are the symptoms of classical angina

A 
no pain at rest
pain with certain level of exertion
pain relieved by rest
patient lives within limits of tolerance
gradual deterioration
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11
Q

What are the signs of classical angina

A 
often none
occasionally hyperdynamic circulation
- anaemia
- hyperthyroidism
- hypervolaemia
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12
Q

What investigations are done for angina

A
  • ECG - resting and exercise (shows area of myocardia ischaemia)
  • Eliminate other disease e.g. thyroid, anaemia, valve
  • angiography
  • echocardiography
  • isotope studies (function assessment)
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13
Q

what causes a coronary artery blockage

A

narrowing caused by plaque

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14
Q

What is the treatment for angina

A

Reduce oxygen demands of the heart

  • reduce afterload (blood pressure)
  • reduce preload (venous pressure)

Increase oxygen delivery to the tissues

  • dilate blocked/ narrowed vessels (angioplasty)
  • bypass blocked/narrowed vessels (coronary artery bypass grafting (CABG)
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15
Q

What is the non-drug therapy for angina

A

Explanation of illness
- live within limitations

Modify risk factors

  • stop smoking
  • graded exercise programme
  • improve diet/control cholesterol
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16
Q

What is the drug therapy for angina

A

Reduce MI risk - ASPIRIN

Hypertension

  • diuretics, Ca channel antagonists
  • ace inhibitors, beta blockers

Reduce preload/ dilate coronary vessels
- nitrates (short acting and long lasting)

Emergency treatment - GTN spray/tab
- short shelf life

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17
Q

What is the surgical therapy for angina

A

CABG

  • benefit not always obtained
  • major surgery (mortality risk)
  • limited benefit (10yrs) and less in smokers who continue to smoke

Angioplasty and Stenting

  • lower risk but lower benefit
  • risk of vessel rupture during procedure
  • need dual antiplatelet therapy
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18
Q

What does CABG stand for?

A

coronary artery bypass graft

19
Q

What is a problem associated with CABG

A

you’re using veins to do the job of arteries, need to turn them the wrong way around (valves)

20
Q

What does angioplasty and stenting achieve

A

gives a scaffold

21
Q

What is peripheral vascular disease?

A

angina of the tissues

22
Q

Where does peripheral vascular disease usually occur

A

lower limb

23
Q

What word describes the type of pain caused by peripheral vascular disease

A

claudication

  • induced by exercise
  • relieved with rest
24
Q

atheroma in what vessels often lead to periperal vascular disease

A

femoral/ popliteal vessels

25
Q

what does peripheral vascular disease lead to

A
  • limitation of function
  • poor wound healing
  • tissue necrosis and gangrene
26
Q

How can ischeamia cause infarction

A

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
27
Q

Where does infarction happen in the heart

A

coronary artery atheroma

28
Q

Where does infarction happen in the limb

A

femoral and popliteal arteries

29
Q

Where does infarction happen in the brain

A

carotid arteries

30
Q

What are the different types of MI

A
  1. Spontaneous
  2. MI secondary to ischaemia
  3. sudden death with symptoms of ischaemia and evidence of ST elevation or thrombus
  4. MI from PCI (percutaneous intervention)
  5. MI from CABG
31
Q

What is the strategy for infarction

A

Reduce tissue loss from necrosis

  • open blood flow to ischaemic tissue (thrombolysis, angioplasty)
  • bypass obstruction (CABG, Fem/pop bypass)

Prevent further episode

  • risk factor management
  • aspirin
32
Q

What happens following a limb infarction

A

medical emergency

  • thrombolysis
  • salvage surgery

may result in acute limb necrosis
- amputation

33
Q

What causes a brain infarction

A

(stroke)

  • usually embolism from atheroma
  • occasionally a cerebral bleed
  • rarely vessel thrombosis
34
Q

How long do strokes last

A

short duration in some patients (<24hrs)

- transient ischaemic attacks

35
Q

What happens after someone has a stroke

A

deficit variable - usually loss of function

  • depends on brain region involved
  • usually some recovery with time

treatment (specialist centres)

36
Q

Symptoms and signs of MI

A

pain, nausea, pale, sweaty
‘going to die’
silent MI’s

37
Q

What are the investigations for an MI

A
  1. ECG

ST segment elevation/ T wave abnormalities

  • varies in position with infarct
  • may be normal!

Q waves only indicate old MI

  1. Cardiac enzymes
    - troponin
    - creatinine kinase
    - LDH and AST increase (not specific)
38
Q

What is the treatment for an MI

A

Primary care

  • Get to hospital
  • Analgesia, aspirin and reassurance
  • Basic life support if required

Hospital

  • Primary PCI
  • thrombolysis if indicated
  • drug treatment to reduce tissue damage
  • prevent recurrence/ complications
39
Q

what is thrombolysis

A

the dissolution of a blood clot, especially as induced artificially by infusion of an enzyme into the blood.

40
Q

what enzyme is used to achieve thrombolysis

A

streptokinase, TPA

- most effective if given early

41
Q

What are the contraindications for thrombolysis

A
  • injury/ surgery/ IM injections
  • severe hypertension, active PUD
  • diabetic eye disease, liver disease, pregnancy
42
Q

What are the complications of MI

A
  • death
  • arrhythmias
  • heart failure
  • ventricular hypofunction and thrombosis
  • DVT and pulmonary embolism
  • complications of thrombolysis
43
Q

What is the medical management of MI

A

Prevent next MI

  • risk modification and aspirin
  • beta blocker
  • ACE inhibitor

Treat complications

  • heart failure
  • arrhythmias
  • psychological distress

BDS2 BAMS Cardiovascular medicine (5 decks)

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