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Flashcards in Coronary Artery Disease Deck (30)
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1

Myocardial Ischaemia

Myocardial demand for O2 and Nutrients outstrips supply.

2

Two disease groups where main pathophysiology is myocardial ischaemia

Stable Angina
Acute Coronary Syndrome

3

3 Types of Angina

Exersional angina pectoris
Varient Angina
Cardiac Syndrome X

4

3 Diseases in Acute Coronary Syndrome

ST Elevation Myocardial Infarction
NSTEMI
Unstable Angina

5

Mechanism of myocardial Ischaemia

Mechanical vessel obstruction
Systemic reduction oxygenated blood flow

6

Local causes of myocardial ischaemia

Atheroma
Thrombosis
Arterial Spasm
Embolus
Coronary Arteritis
Coronay Ostial Stenosis

7

Systemic causes myocardial ischaemia

anaemia
carboxyhaemoglobulinaemia
hypotension

8

Risk factors Coronary artery disease

+ Age
Male
+ family Hx
Smoker
Obesity
High Fat Diet
Sedentary Lifestyle
Psychological stressors
High Alcohol intake
Coagulopathies
NSAIDs -COXIBS

9

calculate risk 5 yearly using ....

QRISK3
>10% statins
<10% lifestyle optimisation

10

Angina features
(is clinical diagnosis)

"Cardiac" chest pain
Central/retrosternal pain
sweating
anxiety with attacks
breathlessness

11

Classical Angina Pectoris

angina pain
provoked by exercise (esp after food/in cold/ emotional)
relieved with rest / GTN

12

Varient Angina (/ Prinzmetal's A)

angina pain
at rest
caused by arterial spasm

13

Cardiac Syndrome X

angina pain
positive exercise test
normal coronary arteries on angiography

14

Angina Investigations
in V High risk patients, likely angina and low risk population

BP: screen comorbid HTN

Bloods: FBC, Cholesterol TFT

ECG: normal between attack
Echo:Screen co-morbid abnormality

Ultra High Risk: Cardiac Catheterisation
Probable Angina: SPECT stress testing
Low risk group: CT angiography

15

Angina Managment

Patient education: lifestyle management, employment, sex, risk

Symptomatic Relief: GTN , BBlocker/CCB
(2nd Line: long active nitrate/ rate control/vasodilator)

Cardiac prevention: Statin, 75mg Asprin (OR cloplidigrel post stroke TIA) (+ ACE inhibitor if DM. CKD, CF)

Treatment resistance = dual therapy with BBlocker AND CCB / referral for revascularisation (PCI/CABG)

16

Unstable Angina

Angina pain:
At rest / prolonged in nature / chreschendoing
NO RISE TROP

17

MI Diagnosis

Prolonged myocardial ischaemia causing death of myocytes.

Trop T >30 @ 6 hours or doubling post 3 hours + at least one of
-Cardiac Pain
-suggestive ECG changes (ST elevation/ q waves)
-recent PCI/CABG

18

Management ACS

Morphine 5mg + Antiemetic
Oxygen 2l nasal cannula (unless COPD etc)
Nitrates GTN
Asprin 300mg
Beta Blocker
Access for revascularistation - Revascularise if suitable

if not suitable
ACE Inhibitor,
Statin
Heparin (Fondaparinux)

19

Revascularisation Options
STEMI / High risk consider for revacularisation

If <12 hours and can have PCI within 2 hours: PCI
If not Fibrinolysis. Alteplase / streptokinase
High risk of complications CABG

20

PCI for Angina

Balloon dilatation and stent induction.

21

Anterior MI

Left Anterior Descending artery
Major cardiac supply

22

Anterior MI ECG signs

ST elevation: in V1-V6 +/- 1 +/- aVL
Tombstoning
Isolated J point elevation

23

Inferior MI ECG signs

ST elevation: II, III, aVF
ST suppression in I & aVL

24

Posterior MI ECG signs

ST depression in v1-v4
R:S wave >1
Posterior ECG ST elevation leads v7-v9

25

New LBBB

STEMI treatment

26

NSTEMI ECG

May be normal
ST depression +/- T wave inversion

27

ST depression in v1-v4
R:S wave >1
Posterior ECG ST elevation leads v7-v9

Posterior MI

28

ST elevation: II, III, aVF
ST suppression in I & aVL

Inferior MI

29

ST elevation: in V1-V6 +/- 1 +/- aVL
Tombstoning
Isolated J point elevation

Anterior MI

30

Post MI secondary prevention

Lifestyle optimisation
Asprin
ACE inhibitor / ARB
Statin

if in heart failure Aldosterone Antagonist