Flashcards in Acute Coronary Syndromes and Stable Angina Deck (13):
What is acute coronary syndrome?
Any group of syndromes attributed to the obstruction of the coronary arteries.
- Unstable Angina
What is myocardial infarction?
Caused by a blood clot which stops the blood flowing to a part of the heart muscle. Common form is blood clot in the coronary artery or one of its branches
What are the 2 types of myocardial infarction?
- ST Elevated: this means that there is an elevation of the ST segment in ECG
- Non ST elevated: No change in ECG
What are the risk factors of myocardial infarctions?
- High Cholesterol
- High BP
- Physical inactivity
- Increased Age
What are the symptoms of myocardial infarction?
- Sudden crushing chest pain that originates at the centre of the chest then radiates to the arms neck or jaw.
What is the treatment of STEMI?
- Aspirin 300mg
- Coronary reperfusion therapy
- Either primary percutaneous coronary intervention with additional antiplatelet agent e.g. Ticagelor or pasgruel or fibrinolytic eg. reteplase, tenecteplase
- Pain relief, anti emetics and glycaemic control
What are the secondary preventions of STEMI?
- Aspirin at low dose - lifelong
- If patient has a stent, dual antiplatelet therapy may be required e.g. ticagelor and aspirin or clopidogrel and aspirin
- PPI to relieve GI side effects of antipatelet
- Beta blockers
- Lipid lowering treatment
- Alodesterone antagonists
What is the treatment of NSTEMI and unstable angina?
- Aspirin 300 mg
- Ticagelor 180mg
- Glycoprotein 2B3A inhibitor - eptifibatide and tirofiban who will undergo coronary angroplasty or abciximab asan adjunct to PCI or coronary artery bypass graft (CABG)
- Pain relief and anti-emetics
What is the secondary prevention of NSTEMI and unstable angina?
- Dual antiplatelet therapy
- Lipid lowering medication: statins
- Beta Blockers
What is the treatment of stable angina?
- GTN for rapid symptom relief
- First line treatment: Beta blocker or calcium channel blocker
- If symptoms not controlled consider switching to another option
- If patients symptoms not controlled or not toelrated then:
- Use long acting nitrate
- If using a CCBs with a BBs or Ivabradine, consider a slow release nifedipine, amlodipine or felodipine. If patient cannot tolerate BBs or CCBs then consider monotherapy with:
- A long acting nitrate
How do nitrates work?
- mimic endogenous NO causing vasodilation which improves coronary blood flow and reducing preload - dilating veins and afterload - dilating arteries.
- Nitrates relax the vascular smooth muscle
What is the prevention method of tolerance to nitrates?
- Nitrate free period
- Should be done at lowest risk at night