The big 6 Flashcards
(46 cards)
What is STEMI?
ST elevated myocardial infarction
What is the pathophysiology of STEMI?
Complete and persistent occlusion of a major coronary artery causing cell death due to ischaemia.
What is the cause of STEMI?
Oxygen demand has exceeded oxygen supply.
What are the risk factors for STEMI?
Increasing age Male Family history Smoking Poor diet Diabetes mellitus Hypertension Hyperlipadaemia.
What are the symptoms for STEMI?
Severe Angina: Crushing chest pain Radiation to left arm, neck and jaw. Dyspnoea Sweating Vomiting Syncope
What would be found upon examination of a patient with STEMI?
Tachycardia
Cardiogenic shock
What investigations are used to diagnose STEMI?
ECG - st segment elevation which may progress to the q wave.
Serum cardiac troponin
CXR
ECHO
What treatment is there available for STEMI patients?
Angioplasty if available within 2 hours - stent opens coronary artery via inflating a balloon.
Thrombolysis - pharmacological treatment used to catalyse plasminogen to lyse the fibrin clot.
Immediate MONA - morphine, oxygen, nitroglycerin and aspirin.
What is the secondary treatment used to prevent further STEMI?
Lower cholesterol - Statins
Lower oxygen demand of heart - Beta blockers
Antiplatelet - Aspirin and Clopidogrel
Lower BP - ACE inhibitors.
What is DVT?
Deep Vein Thrombosis
What is the pathophysiology of DVT?
A blockage arising in deep veins, usually the legs. Clot can migrate from another area and can be blood,fat ,air , tumour.
What causes DVT?
Stasis in deep veins and hypercoagubility.
What are the risk factors for DVT?
Increasing age Tissue trauma Immobility Obesity Smoking Pregnancy Oral contraceptive Systemic disease Thrombophilia
What are the symptoms for DVT?
Unilateral limb swelling Persistant discomfort Calf tenderness Warmth Erythema - redness Prominent collateral veins Pitting oedema
Upon examination of a patient with expected DVT what would you see?
Unilateral limb swelling
Pitting oedema
Redness
What investigations aid the diagnosis of DVT?
Clinical probability assessment (wells scoring) :
0=low risk
1-2=moderate
3 + =high risk
D-dimer blood test: positive indicates DVT but does not confirm it. negative rules out DVT.
Compression ultrasound: can see location and size of obstruction.
What is the available treatment for DVT?
Low molecular weight heparin - anticoagulant that prevents further clots.
Compression stockings - increases blood flow through veins in legs.
Thrombolysis/thrombolectomy - extreme cases.
What is stable angina?
Chest pain due to ischaemia of heart muscle.
What causes angina?
Blood issues:
obstructive atheroma
coronary artery spasm
coronary arteritis
Oxygen supply:
Anaemia
Increased Oxygen demand:
Left ventricular hypertrophy
Thyrotoxicosis
What are the risk factors for angina?
Non-modifiable: Increasing age Race Male Family history Genetics
Modifiable: Smoking Exercise Diet Diabetes Hypertension Hyperlipadaemia
What are the symptoms of angina?
Retrosternal chest pain that feels crushing/heavy.
Radiation to neck/jaw/arms
Dyspnoea on exertion
Symptoms get worse during cold weather, after a large meal, after exercise. They are relieved by rest and GTN spray.
What would be seen on the examination of a patient with suspected angina?
Tar staining Obesity Xanthaslasma Corneal arcus Hypertension Retinopathy AAA Heart failure Basal crackles Peripheral oedema Mitral regurgitation Aortic stenosis
What are the investigations that aid the diagnosis of angina?
Full blood count Lipid profile Blood glucose Thyroid Electrolytes LFTs CXR ECG Exercise tolerance test Myocardial perfusion imaging Coronary angiography
What is the treatment available for angina?
Control of symptoms; Beta blockers Calcium channel blockers K+ channel blockers Nitrates (GTN)
Disease treatment:
Statins
ACE inhibitors
Aspirin or Clopidogrel
Revascularisation:
PCI - percutaneous coronary intervention
CABG if multi-vessel.