Chest Pain Flashcards
(41 cards)
what is angina
discomfort in chest due to NARROWING of coronary arteries and myocardial ischaemia
typical v atypical angina
criteria:
- discomfort in chest radiating to arms, neck, jaw
- worse on exertion
- relieved by GTN spray after 5 minutes
typical = all this criteria atypical = 2 of these
what is the first line treatment for stable angina
GTN spray, 1 dose, 5 minutes, 2nd dose, 5 minutes, then if not relieved = ambulance
what is the long term management for stable angina
1st line: beta blockers - bisoprolol, or CCB (amlodipine)
2nd line: BOTH these
3rd line: ivabradine, nicorandil or ranolazine
and also start on low-dose 75mg aspirin as secondary prevention of CVD
what do you do if no drugs are working for angina
CABG, or PCI if CABG not appropriate
what is unstable angina
angina that is severe and follows no patterns or triggers
what is variant angina
severe pain at night and early morning due to vasospasm of CA = narrowing due to SM contraction
what are the ECG changes in variant angina
ST elevation only during attack and increase in cardiac enzymes
how do you manage variant angina
nitrates, CCB, NOT beta-blockers
what is cardiac syndrome X
signs of myocardial ischaemia but with normal coronary arteries
how do you diagnose ACS
- high troponins
- symptoms of ischaemia
- echocardiography
- stress tests
- identify intracoronary thrombus by angiography
- ECG
what does an abnormal ECG in ACS show?
- transient ST elevation indicating an MI
- ST depression (this and t wave inversion is normally a NSTEMI)
- T wave inversion
what are the 3 complications of an MI?
decreased contractility = coronary vessel perfusion is reduced
atypical conduction = arrtyhmias
tissue necrosis = inflammation, pericarditis and papillary muscles are damaged
what is cardiac tamponade?
fluid or blood in the pericardial sac
what are the ECG signs of a STEMI
- ST elevation (and reciprocal depression in the others)
what are the pharmacological treatments for STEMI
oxygen
morphine
nitrates
300 mg aspirin
what are the time limits and surgical interventions for a STEMI
PCI within 12 hours if you can get there within 2 hours
if not - thrombolysis and rescue PCI if residual ST elevation
what is thrombolysis and how do you give it
alteplase, single IV bolus
what is the imaging used for an NSTEMI
ECG = should show ST depression transthoracic echo stress echo cardiac MRI CT coronary angiography
what is the surgical management for an NSTEMI or unstable angina
coronary angiography with follow on PCI within 96 hours of first admission
how do you treat an NSTEMI (non-emergency) - after an ECG shows
fondaparinux
300mg aspirin
clopidogrel longer term
what is the GRACE score and what does it include
indicates ischaemic risk in hospital and from 6m-3y
age, heart rate, systolic BP, ST segment deviation, troponins, cardiac arrest at admission
what is the CRUSADE score and how does it work
indicates bleeding risk
Baseline haematocrit, GFR, HR on admission, systolic BP, prior stroke, history of DM, signs of CHF on admission, female sex
what is the QRISK tool
estimating the 10 year risk of having a cardiovascular event in people who do not already have heart disease
