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PMP 201 Patient-Centred Learning > Clinical Management of Acute Coronary Syndrome (ACS) > Flashcards

Clinical Management of Acute Coronary Syndrome (ACS) Flashcards

(65 cards)

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1
Q

ACS

A
  • Sudden reduced blood flow
  • Stable angina
  • Unstable angina
  • Non-ST MI
  • ST MI
  • How much occluded
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2
Q

Unstable angina

A
  • Partial transient obstructive thrombus
  • Ischemia without necrosis
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3
Q

NSTEMI

A
  • Partial transient obstructive thrombus
  • Ischemia WITH
    necrosis
  • Partial thickness
    damage on heart walls
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4
Q

STEMI

A
  • Complete obstruction by the intracoronary thrombus
  • Ischemia WITH
    necrosis
  • Full thickness
    damage on heart wall
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5
Q

Symptoms of ACS

A
  • Cheat pain
  • Pain in jaw, teeth, shoulder, arm, stomach and back
  • Light headed
  • Feeling sick
  • Shortness of breath
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6
Q

Site of ACS

A
  • Central chest pain
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7
Q

Onset of angina

A
  • Brought on by physical or
    emotional exertion
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8
Q

Character of angina

A
  • Crushing, squeezing,
    constricting, heaviness
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9
Q

Radiates of angina

A
  • Can radiate to jaw,
    neck, shoulder, arm or
    stomach
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10
Q

Timing of angina

A
  • Brought on by physical or emotional exertion
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11
Q

Exacerbating angina

A
  • Worse after food
  • Cold winds
  • Exercise
  • Stress
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12
Q

Difference between STEMI & NSTEMI

A
  • Brought on by physical or
    emotional exertion OR AT REST
  • Worse symptoms
  • More frequent GNT use
  • Bought on at rest
  • Pain lasts longer
  • Not relieved by GNT initially
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13
Q

Myocardial
Infarction site

A
  • Central chest pains
  • Rapid onset symptoms bought on by physical/ emotional exertion at rest
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14
Q

Myocardial
Infarction character

A
  • Crushing, squeezing,
    constricting, heaviness
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15
Q

Radiation of MI

A
  • Can radiate to jaw,
    neck, shoulder, arm or
    stomach
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16
Q

Timing of MI

A
  • Brought on by physical or emotional exertion or at rest
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17
Q

Exacerbating MI

A
  • Worse after cold winds and eating
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18
Q

Associated symptoms

A
  • Shortness of breath
  • cough
  • Pale & clammy skin
  • Nausea & vomiting
  • Lightheaded & dizzy
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19
Q

ACS in men

A
  • Pain radiates from jaw, neck, shoulders and arms
  • Central heart pains crushing heavy
  • Shortness of breath
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20
Q

ACS in women

A
  • Tiredness
  • Sudden dizziness
  • Shortness of breath
  • Nausea and vomiting
  • Central chest pain crushing
  • Pain neck and jaw
  • Heartburn
  • Cold sweats
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21
Q

Red flags

A
  • Chest pains lasting longer than 15 mins to 20
  • Onset angina symptoms
  • Unresponsive to GTN
  • Nausea vomiting and sweating
  • Urgent 999 call
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22
Q

Diagnosis patient history

A
  • Patient consultation
  • History taking
  • Family history
  • Social history
  • Drug history
  • System review
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23
Q

Risk factors modifiable

A
  • Smoking
  • Diabetes
  • Hypolipidemia
  • Hypertension
  • Obesity
  • illicit drugs
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24
Q

Non-modifiable risk factors

A
  • Age
  • gender
  • family history
  • ethnicity
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25
Unstable angina and NSTEMI
- ST complex depression - May have T wave inversion - No elevation of ST complex
26
STEMI
- Elevation of ST complex
27
Blood test for troponin levels
- Biological marker for cardiac death - Released into circulation when cardiac muscle is damaged - High levels of troponin in blood indicate high MI - Normal <14ng/L if elevated then repeat blood test 3hrs later - >21ng/L most likely MI - Troponin >100 suggest MI with ACS - STEMI or NSTEMI suggest
28
Differential diagnosis
- Acid reflux - Pulmonary embolism (PE) - Anaemia - Muscoskeletal - Collapsing lung - Pericarditis
29
Antianginal drugs
- Prevent or minimize anginal symptoms - Improve long term mortality and morbidity
30
Secondary prevention of angina
- Minimize CV events MI/stroke
31
Glycerin Trinitrate for angina
- Short acting nitrate that dilates blood vessels increase oxygen supply to heart - Used to treat prophylaxis prior to activity bring on angina pain
32
GNT sublingual spray
- Prophylaxis 1 to 2 spray prior to activity under tongue - Repeat after 5 mins - Symptoms not resolved 5 mins 2nd dose and call 999
33
Side effects GNT tablet and spray
- Headache - Low blood pressure - Flushing - Nausea and vomiting
34
Counselling GNT spray
- Dose taken when sitting down and hold breath - Spray under tongue - Press down on button firmly - Close mouth immediately - Don't inhale
35
GNT sublingual tablet
- One tablet under tongue prior to activity - Repeat after 5 mins - No resolve call 999 after 5 mins
36
GNT tablet counselling
- Dissolve tablet under tongue do not swallow - Expire 8 weeks after open
37
First line treatments of angina
- Beta blocker Atenolol or Bisoprolol - Calcium channel blocker Amlodipine, felodipine and dizalitem
38
# 2nd line treatment Angina NICORANDIL
- 10-20mg increased to 40mg if tolerated BD - Side effects - dizziness, haemorrage and ulcer - Monitor potassium levels - Counselling stop taking ulcer is present
39
# 2nd line treatment Angina Ibavradine
- 2.5mg-5mg BD increased to 7.5mg BD after 3-4 week - Side effects - Arrhythmias, headache and vision disorders - Caution AF or other Arrithmyas in elderly - Monitor AF on ECG heart rate for bradycardia
40
# 2nd line treatment Angina isosorbide mononitrate
- Side effects - flushing, headache, arrhythmias - Counselling - Non-MR formulation must be taken at 8am and 2pm to prevent tolerance to the drug developing
41
Secondary prevention
- Aspirin - ACE inhibitor - Statin - Hypertention
42
Life style advice
- Diet - Alcohol consumption - exercise - Stress - Anxiety - Smoking
43
Intial treatment ACS
-ASPIRIN 300mg antiplatelet with FONDIPARINUX 2.5mg once a day
44
Low molecular weight heparin
- Fondiparinux 2.5mg - Inject 5-8 day till - Anticoagulant prevent further clotting
45
STEMI Initial treatment Reperfusion therapy
- Coronary angiography with follow up pre-cutaneous intervention (Gold standard) - Fibrinolysis - Coronary artery revascularisation
46
Coronary angiography
- Take x ray after dye injected visual image of arteries to highligh stenosis due to atherosclerotic plaques
47
Percutaneous coronary intervention
- Stenting where coronary arteries have been identified as stenosed - Stent inserted to widen coronary artery - Use drug eluting stent to prevent body reacting to foriegn object causing clot - Epithelial cells soon grow over so risk minimised - Use Antiplatelet 12 month after
48
Coronary angiograph drug requirements
- Immediately ASPIRIN 300mg as antiplatelet treatment - Immediately TICAGRELOR 180mg or PRASUGREL 60mg - With FONDIPARINUX 2.5mg once daily
49
# Other treatment during initial management Oxygen therapy
should be administered if there is evidence of hypoxia
50
# Other treatment during initial management Ischaemic pain relief
- Nitrates initially sublingual but if pain doesn’t subside - Addition of diamorphine if pain is not relieved
51
# Other treatment during initial management Hyper glycaemic management
- Dose adjust infuser control blood glucose levels - Target of < 11mmol/L
52
Fibrinolysis
Administered to break up the blood clot in the coronary arteries
53
# Fibrinolysis drug ALTEPLASE
- Given within 6 hrs of onset symptoms - Due to risk of bleeding
54
# Fibrinolysis drug STREPTOKINASE
- Given within 12 hours of symptom onset - Due to risk of bleeding
55
Coronary artery revascularisation
- Using a healthy vein to bypass the blocked coronary artery allowing blood flow to be regained - Invasive treatment
56
When perfusion therapy is not indicated (medical management of STEMI)
- Use CLOPIDOGREL 300mg STAT if bleeding risk is high with TICAGRELOR 180mg
57
Initial management of NSTEMI: GRACE scoring tool
- Patients age * Heart rate / pulse * Systolic BP * Creatinine
58
GRACE score interpretation
- <0.3 risk low just use pharmacological methods - <0.6 and >0.3 intermmediate risk and >0.6 high risk concider coronary angiography
59
SECONDARY PREVENTION
- Prevent future cardiac events - Reduce the risk of complications post-MI
60
Secondary prevention pharmacological treatment
- ASPIRIN - TICAGRELOR (or Clopidogrel or Prasugrel) - ACE INHIBITOR (ARB used if ACEI not tolerated) - BETA BLOCKER - STATIN
61
Dual antiplatelet: Asiprin and Ticagrelor
- Aspirin life long with food and Ticagrelor up to 12 months ( monitor renal function) - Reduce development of clots if atherosclerotic plaque ruptures
62
Statin Secondary prevention
- Give 80mg Atorvastatin life long
63
Secondary prevention diet
- Increase bread fruit veg and fish - Decrease meat - Replace butter and cheese with plant based oil foods
64
Secondary prevention alcohol
- Max 14 units in the week spread across 3 days - More drink free days
65
Secondary prevention Physical activity
- 20 to 30 mins of activity a day - More activities and regular exercise

PMP 201 Patient-Centred Learning (51 decks)

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