Ischaemic Heart Disease Flashcards
(43 cards)
What are the classifications of acute coronary syndrome?
Stable angina
Unstable angina
NSTEMI
What is the difference between stable and unstable angina?
unstable occurs at rest
Describe the presentation of acute coronary syndrome
Central crushing chest pain
- Radiation to neck and left arm
Sweating
Dyspnoea
Pallor
Palpitations
What investigations are used in the diagnosis of acute coronary syndrome?
ECG
- T wave inversion
- ST depression
Troponin and CK
FBC
- Anaemia worsens ischaemia
LFTs
U&Es
- Electrolyte abnormalities can cause arrythmias
TFT
- Hyperthyroidism can cause arrythmias
- Hypothyroidism can cause coronary artery disease
Lipids
Glucose, to rule out DKA
Echo
CXR
CT coronary angiogram
Exercise tolerance test, produces symptoms
What is the first line investigation for stable chest pain (after ecg)?
CT coronary angiogram
What biomarker is most useful for determining re-infarction after initial insult?
CK, as it remains elevated for 3-4 days following infarction, whereas troponin remains elevated for 10 days, so can be used to determine if reinfarction between 4-10 day window
What is the acute management of acute coronary syndrome?
MONA greets chest pain at the door
- IV morphine
- Oxygen, if <90%
- IV nitrates
- 300mg aspirin, or 75mg if going on to lifelong
Anti-coagulants
- For NSTEMI instead of thrombolysis
- Ticagrelor, if not high bleeding risk
- Clopidogrel, if high bleeding risk
What is the long-term management of acute coronary syndrome?
B Blocker for symptom relief (bisoprolol 5mg)
CCB, add if angina is not controlled by B blocker
Dual anti-platelet therapy
- 75mg aspirin
- Clopidogrel
GTN Spray, to abort angina attacks as and when required
Statins (atorvastatin 80mg)
What medication is used in dual anti-platelet therapy?
Aspirin
Clopidogrel
Describe angina grade 1
Angina on strenuous or prolonged exertion
Describe angina grade 2
Slight limitation of ordinary activity, angina on moderate activity
Describe angina grade 3
Marked limitation of ordinary activity, angina on mild activity
Describe angina grade 4
Unable to carry out activities without angina, may occur at rest
What are the causes of a STEMI?
Descreased coronary perfusion/ischaemia
Arrythmia
Coronartery vasospasm
Anaemia
HF
Valvular Disease
Hyperthyroidism
What are the risk factors for STEMIs?
HTN
Obesity
Alcohol
Hypercholesteremia and hyperlipidaemia
>Age
Male
FM <50
Smoking
Diabetes
Describe the presentation of a STEMI
Acute onset
Chest pain
- Central
- Crushing
- Radiates to left arm, neck and jaw
Sweating
Dyspnoea
Palpitations
Dizziness
Pallor
What investigations are used in STEMI diagnosis?
ECG
- ST elevation in 2 continuous leads
- ST depression in NSTEMI
- Pathological Q waves suggest prior MI
Biomarkers
- Troponin
- Creatine Kinase
ECHO
- Assess myocardial damage
What is the short term management of a STEMI?
Aspirin
P2Y12-receptor antagonist
- Ticagrelor
- Prasugrel
LMWH/unfractionated heparin if going to cath lab
Cath Lab/coronary intervention within 120 minutes of presenting to hospital
- Primary Percutaneous Coronary Intervention (PCI)
- Coronary Artery Bypass Graft (CABG)
Thrombolysis, offered within 12 hours if unable to get to lab within 120 minutes
Give contraindications for thrombolysis
Active internal bleeding
Recent haemorrhage, trauma or surgery
Coagulation and bleeding disorders
Intracranial neoplasm
Stroke < 3 months
Aortic dissection
Recent head injury
Severe hypertension
What is the long-term management of a STEMI?
Dual anti-platelet therapy
ACEI
Statin
B-Blocker
GTN Spray
Digoxin
What drug is given before percutaneous coronary intervention?
Glycoprotein IIb/IIIa receptor antagonist/anti thrombin drugs
Such as fondaparinux
What score determines if percutaneous coronary intervention is required?
GRACE (Global Registry of Acute Cardiac Events)
Name some complications of STEMIs
Ventricular fibrillation
- Cardiac arrest and death
Cardiogenic shock
LV Aneurysm
- Ischaemic damage weakens myocardium, creating a bulge
- Persistent ST elevation following MI but without chest pain
Mitral regurgitation
- Capillary muscle rupture
Pericarditis/Dressler syndrome
- Common within first 48 hours of a transmural MI
Cardiogenic shock
- Ejection fraction of the heart decreases due to dysfunctional ventricular myocardium
Chronic heart Failure
- Ventricular myocardium is dysfunctional
Acute/flash pulmonary oedema, secondary to mitral regurgitation
Cardiac Tamponade
Ventricular septal defect
What is the most common cause of death following MI?
Ventricular fibrillation
