Angina and MI

Question 1

What are the differential diagnoses for chest pain?

Answer 1

Pulmonary
Cardiovascular
Musculoskeletal

Question 2

What does typical angina present with?

Answer 2

All three of the features:
Precipitated by physical exertion
Constricting discomfort in the front of the chest, in the neck, shoulders, jaw, or arms
Relieved by rest or glyceryl trinitrate (GTN) within about 5 minutes

Question 3

What does atypical angina present with?

Answer 3

2 of the 3 features for typical angina along with atypical symptoms like GI discomfort, breathlessness or nausea

Question 4

What features are likely to lead to a diagnosis of stable angina?

Answer 4

Pain that is continuous or prolonged.
Pain that is unrelated to activity.
Pain that is brought on by breathing.
Pain that is associated with dizziness, palpitations, tingling, or difficulty swallowing

Question 5

What are the different types of angina?

Answer 5

Stable
Unstable
Variant (prinzmetal)

Question 6

How long does stable angina usually last?

Answer 6

Under 5 mins

Question 7

How long does unstable angina usually last?

Answer 7

Longer than 5 mins, can be prolonged

Question 8

What type of angina is relievable by medicine?

Answer 8

Stable angina

Question 9

What type of angina can lead to MI?

Answer 9

Unstable

Question 10

What is pain inn variant angina caused by?

Answer 10

A spasm in the coronary arteries caused by exposure to cold, stress, smoking etc

Question 11

What are some risk factors for angina?

Answer 11

Alcohol use
Tobacco use
High BP
Family history
Gender

Question 12

What are some tests performed for angina clinically?

Answer 12

ECG
Coronary angiography
Exercise tolerance test
Lab tests
Troponin

Question 13

What are troponin levels after heart damage?

Answer 13

They are elevated within a few hours of heart damage and remain elevated for up to two weeks

Question 14

If troponin is normal, what is likely the pain is caused by and what is it less likely the pain is caused by?

Answer 14

More likely that the pain is due to stable angina

Less likely that the symptoms and chest pain are due to heart muscle damage

Question 15

What are first line treatments for stable angina?

Answer 15

Short acting nitrates with beta blocker or CCB

Other options if heart rate is low or if symptoms remain uncontrolled

Question 16

What type of MI occurs if the LCA and LAD are involved?

Answer 16

Anterior

Question 17

What type of MI occurs if the LCx is involved?

Answer 17

Lateral

Question 18

What type of MI occurs if the RCA is involved?

Answer 18

Inferior

Question 19

What type of MI occurs if the RCA and LCx are Involved?

Answer 19

Posterior

Question 20

What type of MI occurs if the LAD is involved?

Answer 20

Septal

Question 21

In anterior MI where is ST segment elevation found?

Answer 21

V1-V4

Question 22

In lateral MI where is ST segment elevation found?

Answer 22

I, avL, V5, V6

Question 23

In inferior MI where is ST segment elevation found?

Answer 23

II, III, aVF

Question 24

In posterior MI where is ST segment elevation found?

Answer 24

V7-V9

Question 25

In septal MI where is ST segment elevation found?

Answer 25

V1 and V2

Question 26

What type of angina is STEMI?

Answer 26

Stable

Question 27

What is the management for STEMI?

Answer 27

Antiplatelet and add-on anti-ischemic/anticoagulant treatment Reperfusion therapy (first line: primary PCI), alternative only if PCI unavailable, thrombolysis (if within the window) or rescue PCI if thrombolysis fails or CABG) Long-term management

Question 28

What happens to the ST segment in STEMI vs NSTEMI

Answer 28

``` STEMI= ST segment elevation NSTEMI= ST segment depression and T wave inversion ```

Question 29

What is the main difference between STEMI and NSTEMI?

Answer 29

Pathophysiology: STEMI= nearly always coronary plaque rupture resulting in thrombosis formation occluding a coronary artery NSTEMI= incomplete thrombus formation

Question 30

What does incomplete thrombus formation is NSTEMI cause?

Answer 30

Blood and oxygen is not completely stopped but the restriction is so great that the oxygen content is used up quickly In the distal arteries and arterioles, tissue death occurs as a result of oxygen starvation The area affected is small, not enough to cause ST elevation but enough to cause minor ST/T wave changes and troponin elevation

Question 31

Describe the lumen in STEMI vs NSTEMI

Answer 31

``` STEMI= completely blocked, no oxygen supply to tissue NSTEMI= only partially blocked, even if plaque is unstable and ruptures theres enough lumen to allow blood flow that meets oxygen demand during rest ```

Question 32

What are the 2 acute coronary syndrome types and how are they differentiated on ECG?

Answer 32

``` STEMI= will have ST elevation NSTEMI= no ST elevation ```

Question 33

What is the difference between unstable angina and NSTEMI

Answer 33

NSTEMI= raised troponins | Unstable angina= normal troponins

Question 34

How do we decide how to treat unstable angina/ NSTEMI?

Answer 34

Perform a risk assessment If they are low risk do a stress test and if positive do coronary angiography If they are high risk invasive management is need eg CA, CABG, PCI