Angina, ACS + MI Flashcards by Hannah Gibson

Causes of angina

CHD most commonly

HOCM, valve disease, arrhythmias, anaemia, thyrotoxicosis

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S+S angina

Pain - episodic, central crushing/ band like, radiating to jaw/ neck/ arms
Precipitated by exertion, cold, emotion + heavy meals
Relieved by rest + GTN spray
Associated with palpitations, sweating, nausea, SOB

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RF for angina

Smoking, fam hx, hx of CVA/ TIA/ VTE

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Investigations for angina

Bloods

12 lead resting ECG

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Non-pharmacological treatment of angina

Smoking cessation 
Treat HTN 
Diet - oily fish, low cholesterol 
Reduce alcohol 
Increase exercise

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Driving + angina

Group 1 - stop until symptoms controlled if attack was during rest, at wheel or with emotion
Group 2 - inform DVLA + revoked license until symptom free for >6 weeks

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PRN treatment + SE for angina

GTN 1-2 puffs as needed

SE: flushing, headaches, light headedness

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Regular treatment for angina

B blocker or Ca channel blocker
2nd line: combine
3rd line: long acting nitrates, nicorandil, ivabradine

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What is secondary prevention of angina?

Aspirin 75mg OD or clopidogrel if aspirin intolerant
Statins to decrease total cholesterol
ACEi decrease deaths

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When should angina be referred to cardiology?

Unstable/ rapidly progressing
aortic stenosis + angina 
Angina following MI
Abnormal ECG 
Angina not controlled by 2 drugs 
Strong family hx

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What is unstable angina?

Pain with no exertion/ at rest

Angina that is rapidly worsening in intensity, frequency or duration

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When to use surgery for angina + what options are there?

If symptoms not controlled with 2 drugs
Coronary revascularisation with bypass surgery (CABG) or percutaenous intervention (PCI)

CABG better in DM, >65 y/o, left anterior descending artery disease

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What is prinzmetal/ variant angina?

Angina at rest resulting from coronary artery sparm
ECG shows ST elevation
Ca channel blockers to prevent
GTN spray PRN

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What is cardiac syndrome X?

Ongoing angina symptoms despite normal coronary angiography

Treat with B blockers/ Ca channel blockers

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Driving post MI

Group 1: stop driving for 1 week if successfully treated with angioplasty, otherwise for 1 month
Group 2: license revoked, review after 6 weeks

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Sexual activity post MI

No increased risk - safe to do so around 4-6 weeks after

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Return to work guide post MI

Sedentary jobs = 4-6 weeks
Light manual = 6-8 weeks
Heavy manual = 3 months

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Drug treatment post MI

ACEi
Aspirin
Clopidogrel/ ticagrelor for up to 12 months in NSTEMI, 4 weeks in STEMI
B blocker for 12 months (diltiazem/ verapamil if CI)
Statins
Spironolactone if signs of HF

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Antiplatelet therapy post MI

Aspirin indefinitely
Ticagrelor/ clopidogrel for 12 months in NSTEMI or PCI/ stent
4 weeks only in STEMI

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What is dressler syndrome?

Study These Flashcards

Develops 2-10 weeks post MI - due to autoantibodies to heart muscle
Recurrent fever + chest pain+ pleural/ pericardial effusion

Treat with steroids + NSAIDs

Statin therapy cautions

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Inhibit liver enzymes P450
LFTs need checking within 3 months of starting statins + after 12 months
Take at night due to cholesterol being made at night

SE of statins

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Rhabdomyolysis + muscle breakdown - muscle aches + pains

B blockers therapy monitoring

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Check HR - caution with bradycardia

Check BP

ACEi therapy monitoring

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U+Es - can cause postural hypotension + hyperkalaemia

Can cause AKI (also with NSAIDs)

?ACS investigations

ECG and troponin | TFTs, cholesterol, BM (can get raised even non-diabetics), FBCs, U+Es

ACS troponin results

Raised after 4-8hrs, peak 18-24, elevated for 10 days

STEMI investigations results + characteristic presentation

Raised troponin, ECG ischaemia (ST elevated, new LBB, T wave inversion) Chest pain not relieved by GTNN+V, clammy, chest pain Elderly + diabetics can get painless STEMIs - presenting as delirium

NSTEMI investigations results + characteristic S+S

Chest pain, raised troponin, ECG can show ischaemia (ST depression, T wave inversion)

Angina investigations results + characteristic S+S

Chest pain, no raised troponin, no ECG ischaemia

ACS acute management

``` MONATH Morphine 10mg IV O2 (if critically unwell) GTN spray Aspirin 300mg stat Ticagrelor 180mg Heparin (if angiography likely in 24hrs) or fondaparinux (if PCI unlikely) BB or diltiazem if they are contraindicated ```

STEMI acute management

MONATH (remember - heparin if PCI is likely) Coronary angiography + PCI if it can be done within 120 mins, fibrinolysis if not Fibrinolysis with alteplase

NSTEMI acute management + criteria used to assess

BEMOAN / MONATH + BB BB Enoxaparin Morphine O2 Aspirin Nitrates GRACE criteria (risk of death or MI in hospital in 6 mths) Low risk = fondaparinux + ticagrelor (continue for 12 months) High risk (>3%) = Intravenous glycoprotein IIb/IIIa receptor antagonists (eptifibatide or tirofiban) + PCI within 96 hours TIMI risk score >3 = LMWH + angiography

PCI eligibility

Need Chest pain and ECG changes or chest pain within 12hrs and ECG change On ECG need ST elev over 2 in chest lead, 1 in limb, or new LBBB

Minimum long term therapy after ACS

``` Aspirin Clopidogrel Beta blocker Ace inhibitor Statin ```

Flow chart for cardiac arrest

Unconscious - call resus team - head tilt chin lift - CPR 30:2 - attach defib - assess rhythm Adrenaline every 5 mins (1mg IV) + amiodarone after 3 shocks

What is a type I MI?

Caused by plaque rupture

What is a type II MI?

``` MI secondary to ischaemia due to increased O2 demand or decreased supply, due to: Coronary artery spasm Coronary embolism Anaemia Arrhythmias HTN Hypotension ```

Reversible causes of cardiac arrest

``` Hypoxia Hypovolaemia Hypothermia Hypo/hyperkalaemia H+ (acidosis) ``` Tension pneumothorax Tamponade Toxins Thrombosis

When to offer coronary angiography + PCI for an acute STEMI?

If symptoms within 12 hours of onset + if primary PCI can be delivered within 120 mins of time when fibrinolysis could have been given

What is the criteria for a STEMI?

1mm STEMI in inferior lead 2mm STEMI in anterior lead New onset LBBB

What does a posterior MI look like on ECG?

V1 - V3 ST depression

What do leads V1 + V2 show?

Right ventricle

Which ECG lead shows right atrium?

AVR

When + where is T wave inversion normal?

Normal in V1+V2 (normal in females) + v1,2,3 in Afro-caribbeans

Complications of MI

``` CRASH PAD Cardiac Rupture Arrhythmia Shock HTN/ HF Pericarditis/ PE Aneurysm DVT ```

What is PCI?

Percutaneous coronary intervention | Balloon angioplasty or stenting

What is CABG?

Coronary artery bypass graft surgery | For stenosed CA

When would you do CABG over PCI?

Triple vessel or left main disease | DM

S+S of MI in elderly women

Dizziness, back pain, light-headedness, weakness

Angina, ACS + MI Flashcards

(49 cards)