Flashcards in Ischaemic Heart Disease Deck (49)
How soon after an MI can patients return to sexual activity?
What are the driving rules after an MI?
Car drivers can return to driving after 4 weeks and do not have to inform the DVLA. HGV/bus drivers can return to driving after 6 weeks and must inform the DVLA.
As a result of VSD or sub-mitral valve papillary muscle rupture, what murmur may develop after an MI? How does it sound?
Mitral regurgitation / pansystolic murmur
What is Dressler's syndrome?
Autoimmune pericarditis occurring 2-10 weeks after an MI
Describe what is involved in the MONA acronym for the initial treatment of STEMI?
Morphine (+ anti-emetic), oxygen (only if hypoxic), nitrates, anti-platelets (aspirin + ticagrelor)
What are the interventional management options for STEMI?
Primary PCI or thrombolysis
What anti-emetic should be given alongside IV morphine when treating NSTEMI?
How can GTN be given in a STEMI?
Sublingual, oral or IV
Which patients should be given nitrates when treating a STEMI?
If systolic BP > 90mmHg
What dose of aspirin, clopidogrel and ticagrelor should be given in the acute treatment of a STEMI?
300mg aspirin + clopidogrel, 180mg ticagrelor
What are some potential interventions for the primary prevention of ACS?
Smoking cessation, cholesterol reduction, tight control of hypertension/diabetes
In addition to chest pain and dyspnoea, what are some other potential symptoms of ACS?
Which acute coronary syndrome(s) will cause chest pain that is relieved by GTN spray?
Which acute coronary syndrome(s) may cause an abnormal ECG?
NSTEMI and STEMI (NSTEMI may or may not be abnormal, STEMI will always be abnormal)
Which acute coronary syndrome(s) will cause a rise in troponins?
NSTEMI and STEMI
Which ECG leads, and which artery, correspond to the anteroseptal territory of the heart?
V1-V4, left anterior descending artery
Which ECG leads, and which artery, correspond to the lateral territory of the heart?
I, aVL, V5 & V6, left circumflex artery
Which ECG leads, and which artery, correspond to the inferior territory of the heart?
II, III & aVF, right coronary artery
What ECG change can be seen in a posterior STEMI?
ST depression in the anterior leads V1-V4
When a patient presents with a possible ACS, what 3 basic investigations should be done ASAP?
ECG, CXR, bloods (FBC, U&E, lipid profile, troponins)
What is the gold standard investigation for ACS?
For best results, when should a measurement of troponin be taken?
12 hours after the onset of pain
What medical management is required for cases of NSTEMI and unstable angina?
Dual anti-platelet therapy and an anti-coagulant
What can be used for pain control in cases of NSTEMI/unstable angina? What should be co-prescribed?
IV opiates and nitrates / co-prescribe an anti-emetic
In which group of patients should anticoagulation not be given, when presenting with NSTEMI/unstable angina?
If cardiac catheterisation is scheduled for the same day
What interventional management options may be offered to patients with NSTEMI/unstable angina?
PCI or CABG
Describe the typical clinical feature of angina?
Chest pain which is worse on exertion and relieved by rest and the use of GTN spray
What are some non-modifiable risk factors for the development of ischaemic heart disease?
Increasing age, male gender, family history
What are the four main modifiable risk factors for the development of ischaemic heart disease?
Smoking, diabetes, high cholesterol, hypertension