CVASC2 Flashcards

Question

Before administration of GTN spray what must you ensure?

Answer 1

Blood pressure is at least **100 systolic** **IV access is obtained** - as patient may have profound hypotension and require IV fluids.

Answer 2

Within 10 minutes of arrival If ongoing pain or results are unclear - then repeat eveyr 15 mins

Answer 3

STEMI - ST elevation Myocardial infarction NSTEACS - Non ST elevation coronary syndromes - which can be further divided into Non ST elevation infarcts (NSTEMIs) and unstable angina

Answer 4

Reperfusion - achieved through PCI **or** fibrinolytic therapy

Answer 5

Plaque stabilisation and prevention of coronary occlusion with a) medical therapy and/or b) revascularisation if appropriate (PCI or bypass graft)

Answer 6

Very High risk - within 2 hours of admission High risk - within 24 hours Intermediate risk - within 78 hours

Answer 7

12 months after acute episode unless post stent - refer to cardiology for further advice in this scenario

Answer 8

Antiplatelet therapy (Aspirin) (1) Indications: (1) - reduces incidence of death, recurrent MI or stroke - platelet inhibition/prevent platelet aggregation Dual antiplatelet therapy/P2Y12 inhibitor (1) Indications: (1) - reduces incidence of death, recurrent MI or stroke compared to aspirin alone - platelet inhibition/prevent platelet aggregation Statin/HMG-coA reductase inhibitor (1) Indications: (1) - reduce low density lipoprotien cholesterol (LDL-C) - reduce arterial inflammation - stabilise lipid core - help regress atherosclerotic plaque - reduce annual risk of major vascular events ACE inhibitor (or angiotensin receptor blocker) (1) Indications: (1) - cardioprotective effect - limit infarct size - reduce ventricular remodelling Beta-blocker (1) Indications: (1) - reduce peripheral vascular resistance - maintain or improve cardiac output - maintain or improve stroke volume - maintain or improve left ventricular function - may limit infarct size - reduce mortality post MI

Answer 9

Aldosterone Antagonist -For patients with left ventricular dysfunction - LVEF less than 40% and heart failure, or diabetes. Epleronone reduces morbidity and mortality after ACS.

Answer 10

A) Heart Failure B) In combination with Beta Blocker C) IN combination with dihydropyridine calcium channel blocker DONT GIVE IN THESE CASES

Answer 11

Glyceryl trinitrate spray 400mcg sublingual PRN **AND MONOTHERAPY WITH ONE** of the following **BB:** Atenolol 50mg daily or Metoproplol 50mg bd **DPCCB** :Amlodipine or felodipine (5-10mg daily) **NDPCCB:**Verapamil 160daily or Diltiazem 180 daily **Nitrate:**Isosorbide mononitrate 60-120mg daily **Potassium channel activator:**Nicorandil (eg. Add Isosorbide mononitrate 60mg daily)

Answer 12

High risk NSTEACS - Coronary angiogram Low or intermediate risk NSTEACS - Functional tests (stress Echocardiogram and stress ECG).

Answer 13

Can reclassify moderate risk patients as high or low risk

Answer 14

DHA and EPA reduce cardiac morbidity and mortality. They are thought to be antiplatelet, anti thrombotic, antiinflammatory All Australians should consume 500mg of DHA and EPA daily. (One 1000mg fish oil capsule contains 300mg) Individuals with coronary artery disease should consume 1000mg of DHA and EPA daily. (can be achieved by 2-3 serves of oily fish a week and fish oil capsules). Consume 2-3g of phytosterols daily (if at high risk of CAD).

Answer 15

Duration of symptoms of Myocardial infarction greater than 20 minutes Less than 12 hours have elapsed since onset of symptoms ECG changes of either 1mm ST elevation in 2 contiguous limb leads or 2mm in 2 contiguous chest leads

Answer 16

**Dual antiplatelet therapy**: Aspirin 100mg orally daily Clopidogrel 75mg orally daily **Betablocker (**contraindicated in heart block, decompensated heart failure, bradycardia,) Metoprolol 50mg orally twice daily **ACE inhibitor**: Ramipril 1.25mg orally daily (titrate dosage up to 10mg) (monitor for renal impairment, hyperkalaemia, and hypotension) **HMG CoA Reductase inhibitor**: Atorvastatin 40mg orally once daily

Answer 17

Left ventricular failure Cardiogenic shock Mural thrombus Arrhythmia Pericarditis

Answer 18

Consider long term anticoagulation to prevent emboli from a mural thrombus in patients who've had a large MI (esp with large dyskinetic or akinetic area) IF Echo demonstrates mural thrombus then anticoagulate - usually warfarin

Answer 19

A syndrome caused by signficant reduction in cardiac output - results in hypotension with signs of hypoperfusion including oliguria 1. Immediate transfer to tertiary centre for more advanced cardiac support 2. Management of hypotension may include ionotropic support including: **Adrenaline 1 to 20mcg/by IV infusion** seek expert advice on other ionotropes 3. If sudden clinical deterioration consider cardiac rupture- Immediate confirmation of cardiac tamponade by echocardiogram with pericardiocentesis can be lifesaving.

Answer 20

A life threatening Cx accompanies inferior infarction suggested by ST Elevation in V4R Confrimed by ECHO Clinical features: signs of right heart failure - eg Raised JVP, AND low Cardiac output signs - hypotension, oliguria, shock BUT with NO pulmonary congestion - clear chest sounds and chest xray Give 200ml 0.9NACL fluid challenge over 30 minute period (repeat dose as required).

Answer 21

II, III, AVF

Answer 22

I, AVL, V4-V6

Answer 23

Broad complex tachycardia - HR 90 No P waves Accelerated idioventricular rhythm - Common benign reperfusion arrhythmia

Answer 24

They can reduce their efficacy - change to H2 receptor antagonist if possible or to pantoprazole.

CVASC2 Flashcards

(50 cards)