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Flashcards in MI Deck (23)
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1

What is angina?

Chest pain caused by reduced blood flow to heart muscle
If stable - GTN can be used for rapid relief of symptoms

2

Difference between stable and unstable angina?

Stable - attacks have triggers, rarely last longer 10 mins, GTN relieve
Unstable: unpredictable, can continue despite rest

3

What wouldn't be consistent with angina?

Crushing sever central chest pain
Clammy/ feel sick - over activation sympathetic nervous system

4

What is GTN?

Nitrate - widen blood vessel to increase blood flow
Pain angina usually last <3 min if not relieved GTN

5

Consequence GTN

Headache

6

What is acute coronary syndrome?

Modern diagnosis - include angina and MI
Can't differentiate until tested in hospital setting

7

Medical emergency management

MONA
Morphine - coronary artery relaxation
Oxygen
Nitrare - relax coronary blood vessel
Aspirin - 300mg - reduce platelet activation

8

What is MI?

Narrowing of coronary arteries due to plaque - become dislodged and occlude vessel
Unresponsive to angina medication

9

Symtoms MI

Nausea, vomit, sweating, palpitation, breathlessness, fainting, pain left arm (nerve branch from heart and those left arm sent same place - hard to differentiate)

10

Tx of MI

Anticoagulation
Angiography - stenting
Secondary prevention - DAPT year
Cardiac rehab

11

What is NSTEMI

No change in ECG - blood supply may only be partially blocked

12

RF NSTEMI

Smoker, physically inactive, high BP, diabetes

13

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)
ECG

14

Why elevated JVP heart failure?

No valves between internal jugular and right heart -if damming of blood RHS JVP may rise

15

Difference between RHS and LHS heart failure?

RHS - peripheral oedema, raised JVP

LHS: (oxygenated blood): fatigue, pulmonary oedema

16

What could you use other than troponin and disadv?

Creatine kinase - related to muscle break down therefore can be inaccurate

17

What is troponin?

Molecule related to contractibility of heart - cardiac specific
Take 6-12 hour to show - 3 hours if sensitive

18

Management of STEMI

1. Thrombolysis - kinases
2. PCI - percutaneous coronary intervention = stent

19

Why is PCI not always option?

Need qualified cardiologist and access to cardiology unit

20

Use of angiogram?

Aid placement of stent - use iodine

21

Use treadmill test in unstable angina?

Look ST depression - if have unstable angina and ST depression w/ exercise may indicate PI

22

Tx pt in dental setting 8 months later

NSTEMI - will be on clopidogrel
If dual therapy - haematology advice
First 6 month -tx hospital

23

Medication used to reduce death on discharge?

A- aspirin
A- ACE inhib
B- beta-blocker
C- clopidogrel (STEMI 1 month, NSTEMI - 1 year)
S- statin