2. Acute Coronary Syndromes

Question 1

Processes involved with CVS diseases (2)

Answer 1

Ischaemia

Infarction

Question 2

Definition of ischaemia

Answer 2

Blood vessel narrowing

Question 3

Ischaemia action (3)

Answer 3

Inadequate oxygen delivery for tissue needs
‘Cramp’ in affected tissue/muscle
No residual defect at first

Question 4

Examples of ischaemic diseases (2)

Answer 4

Angina pectoris

Peripheral vascular disease (PVD)

Question 5

Definition of infarction

Answer 5

Blood vessel occlusion

Question 6

Infarction action (3)

Answer 6

No oxygen delivery, resulting in tissue death
More severe pain
Loss of tissue funciton

Question 7

Examples of infarction diseases (2)

Answer 7

MI

CVA

Question 8

Definition of angina pectoris (2)

Answer 8

Reversible ischaemia of heart muscles

Involves narrowing of one or more coronary arteries

Question 9

Aetiology of angina

Answer 9

Narrowing and hardening of coronary arteries (atherosclerotic plaques)

Question 10

Effect of angina (2)

Answer 10

Reduces blood supply to heart

Reduces oxygen concentration to heart

Question 11

Mechanism of angina (3)

Answer 11

Reduced oxygen concentration to heart
Myocardial cells switch from aerobic to anaerobic respiration
This progressively impairs metabolic, mechanical and electrical functions

Question 12

Cause of angina pectoris

Answer 12

Chemical and mechanical stimulation of sensory afferent nerve endings in the coronary vessels and myocardium (nerve fibres from T1-T4)

Question 13

Different types of angina (2)

Answer 13

Classical

Unstable

Question 14

Differences between classical and unstable angina (2)

Answer 14

Classical - worse with exacerbation/exercise

Unstable - more unpredictable, with symptoms seen at rest with no biomarkers

Question 15

General angina symptoms (7)

Answer 15

Central, crushing chest pain/discomfort (tight, dully or heavy)
Pain radiates to arm, back, jaw
Breathlessness
Nausea
Feeling unusually tired
Dizziness
Restlessness

Question 16

Classical angina symptoms (5)

Answer 16

No pain at rest
Pain with certain level of exertion (cold weather)
Pain relieved by rest
Patient lives within limit of tolerance
Gradual deterioration over time

Question 17

Classical angina signs (2)

Answer 17

Often none

Occasionally, when not caused by atherosclerosis alone, hyper dynamic circulation

Question 18

Components of hyperdynamic circulation

Answer 18

Anaemia
Hyperthyroidism
Hypervolaemia

Question 19

Angina investigations (5)

Answer 19

ECG
Eliminate other diseases (thyroid, anaemia, valve)
Angiography
Echocardiography
Isotope studies (function assessment)

Question 20

ECG results for angina (3)

Answer 20

Shows areas of myocardial ischaemia
Angina will appear as an ST segment elevation
AS angina worsens, ST segment will lower, finally showing as an ST segment depression

Question 21

Angina treatment (2)

Answer 21

Reducing oxygen demands of the heart

Increase oxygen delivery to tissues

Question 22

Methods to increase oxygen delivery to tissues (2) and descriptions (2)

Answer 22

Angioplasty/stenting - dilating blocked/narrowed vessels. Stretch artery back to normal size. Method of percutaneous intervention (PCI)
CABG (coronary artery bypass grafting) - bypass blocked/narrowed vessels

Question 23

Non-drug angina therapies (2)

Answer 23

Explaining illness (learning to live within limitations)
Modifying risk factors

Question 24

Angina drug therapies (4) and example treatments (4)

Answer 24

Reduce MI risk - aspirin
Target hypertension - diuretics, Ca-channel blockers, ACE inhibitors, B-blockers
Reduce preload/dilate coronary vessels - nitrates
Emergency treatment - GTN

Question 25

Definition of PVD

Answer 25

Angina of tissues, usually lower limbs

Question 26

Cause of PVD

Answer 26

Due to atheroma in femoral/popliteal vessels

Question 27

Complications of PVD (4)

Answer 27

Claudication in limbs on exercise Limitation of function Poor wound healing May lead to tissue necrosis and gangrene

Question 28

PVD management

Answer 28

As with angina

Question 29

Infarction mechanism (3)

Answer 29

Atheroma in vessel causes thrombosis on surface which can rapidly enlarge, occluding the vessel Atheroscerotic plaque detaches from vessel wall, travelling in the blood Plaque blocks vessel, preventing blood flow

Question 30

Where can infarction occur (3)

Answer 30

``` Coronary artery (heart) Femoral/popliteal artery (limb) Carotid artery (brain) ```

Question 31

Types of infarction (5_

Answer 31

``` Spontaneous (primary coronary event) MI secondary to ischaemia Sudden death with symptoms of ischaemia and evidence of ST elevation/thrombosis MI from PCI MI from CABG ```

Question 32

Strategy for treating infarctions (2)

Answer 32

Reducing tissue loss from necrosis (angioplasty/thrombolysis, CABG) Prevent further episode (risk factor management, aspirin)

Question 33

Definition of TIA

Answer 33

Transcient ischaemic attack - mini stroke of short duration (<24hrs)

Question 34

Effects of TIA

Answer 34

Defects variable, usually causes loss of function

Question 35

MI symptoms (5)

Answer 35

``` Pale Nausea Sweaty Pain radiates from chest/down arm Patient feels like they're going to die ```

Question 36

MI investigations (2)

Answer 36

Cardiac enzymes - troponin measured as it leaks from dead cardiac muscle

Question 37

MI ECG results

Answer 37

ECG - abnormalities vary in position with infarct, but may be normal

Question 38

Primary care MI treatment (4)

Answer 38

Get patient to hospital Administer analgesia and aspirin Reassure patient BLS if required

Question 39

Hospital MI treatment (4)

Answer 39

Primary PCI (if within 3 hours) Thrombolysis if indicated (if PCI unavailable) Drug treatment to reduce tissue damage Prevent recurrence/complications

Question 40

Hospital care drugs

Answer 40

Aspirin | Thrombolysis (streptokinase, TPA)

Question 41

Side effects of TPA

Answer 41

TPA will dissolve all clots, not just local clots

Question 42

Thombolysis contraindications (8)

Answer 42

``` Injury Surgery IM injections Severe hypertension PUD Diabetic eye disease Liver disease Pregnancy ```

Question 43

MI complications (6)

Answer 43

``` Death Arrhythmias HF Ventricular hypo function and thrombosis DVT and pulmonary embolism Thrombolysis complications ```

Question 44

Medical management of MI (2)

Answer 44

Prevent next MI | Treat complications

Question 45

Preventing next MI involves (4)

Answer 45

Modify risk factors Aspirin B-blocker (reduce excitability of heart and reduce arrhythmia effect) ACE inhibitor Combo. of aspirin, B-blocker, ACE inhibitor suggests patient is a previous MI sufferer

Question 46

Treating complications include (3)

Answer 46

HF Arrhythmias Psychological stress