Acute Coronary Syndromes and Stable Angina Flashcards Preview

HDT 2.2 - Cardiovascular System > Acute Coronary Syndromes and Stable Angina > Flashcards

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.
This includes
- 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?

- Smoking
- High Cholesterol
- High BP
- Physical inactivity
- Obesity
- Diabetes

- Increased Age
- Male
- Race


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
- ACEi
- 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
- ACEi
- 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
- Ivabradine
- Ranolazine

- 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
- Ivabradine
- Ranolazine


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


What is contraindicated with nitrates?

Slidenail (Viagra)