Flashcards in MI Deck (23)
What is angina?
Chest pain caused by reduced blood flow to heart muscle
If stable - GTN can be used for rapid relief of symptoms
Difference between stable and unstable angina?
Stable - attacks have triggers, rarely last longer 10 mins, GTN relieve
Unstable: unpredictable, can continue despite rest
What wouldn't be consistent with angina?
Crushing sever central chest pain
Clammy/ feel sick - over activation sympathetic nervous system
What is GTN?
Nitrate - widen blood vessel to increase blood flow
Pain angina usually last <3 min if not relieved GTN
What is acute coronary syndrome?
Modern diagnosis - include angina and MI
Can't differentiate until tested in hospital setting
Medical emergency management
Morphine - coronary artery relaxation
Nitrare - relax coronary blood vessel
Aspirin - 300mg - reduce platelet activation
What is MI?
Narrowing of coronary arteries due to plaque - become dislodged and occlude vessel
Unresponsive to angina medication
Nausea, vomit, sweating, palpitation, breathlessness, fainting, pain left arm (nerve branch from heart and those left arm sent same place - hard to differentiate)
Tx of MI
Angiography - stenting
Secondary prevention - DAPT year
What is NSTEMI
No change in ECG - blood supply may only be partially blocked
Smoker, physically inactive, high BP, diabetes
Diagnosis MI - STEMI/NSTEMI
Need 2 out of 3: chest pain, ECG feature, positive troponin
Blood test - serum troponin (need wait for levels to rise)
Why elevated JVP heart failure?
No valves between internal jugular and right heart -if damming of blood RHS JVP may rise
Difference between RHS and LHS heart failure?
RHS - peripheral oedema, raised JVP
LHS: (oxygenated blood): fatigue, pulmonary oedema
What could you use other than troponin and disadv?
Creatine kinase - related to muscle break down therefore can be inaccurate
What is troponin?
Molecule related to contractibility of heart - cardiac specific
Take 6-12 hour to show - 3 hours if sensitive
Management of STEMI
1. Thrombolysis - kinases
2. PCI - percutaneous coronary intervention = stent
Why is PCI not always option?
Need qualified cardiologist and access to cardiology unit
Use of angiogram?
Aid placement of stent - use iodine
Use treadmill test in unstable angina?
Look ST depression - if have unstable angina and ST depression w/ exercise may indicate PI
Tx pt in dental setting 8 months later
NSTEMI - will be on clopidogrel
If dual therapy - haematology advice
First 6 month -tx hospital