2. Angina, Nstmi, Stemi Flashcards
Acute coronary syndrome
ACS
What is it
Acute coronary syndrome is a term used to describe a range of conditions associated with sudden, reduced blood flow to the heart
Including
Unstable angina
Non- ST- elevated myocardial infarction
ST- elevated myocardial infraction
What is
Unstable angina
Unstable angina is a condition in which your heart doesn’t get enough blood flow and oxygen. It may lead to a heart attack
Unstable angina
SYMPTOMS
Chest pain that you may also feel in the shoulder, arm, jaw, neck, back, or other area.
Discomfort that feels like tightness, squeezing, crushing, burning, choking, or aching.
Discomfort that occurs at rest and does not easily go away when you take medicine.
Shortness of breath.
Sweating
ACS
Secondary Prevention
(Long term Managment)
ACS AB
A aspirin
S statin
C clopidogrel (4weeks in stemi; 1 yr in NSTEMI /UA)
A ace/arb
B bb
ACS
Secondary Prevention
(Long term Managment)
If bb not tolerated
How to treat
ARC
rivaroxaban 5mg (low dose)
Aspirin 75
Clopidogrel 150 for 1 yr
Length of treatment
Clopidogrel
In
STEMI
4 weeks
Length of treatment with clopidogrel in
UA/NSTEMI
1 yr
Initial treatment of ACS
6
- O2 at 97% or more (COPD lower is normal)
- GTN SL/IV or IV ISOSORBIDE
- Aspirin 300mg + Clopidogrel 300mg (+ note)
- IV morphine/ dimorphine
+
IV metroclopramide - PCI preformed within 120 mints of MI
Or
Thromolytic given: alteplase (within 4.5hrs)
Or
Streptokinase (within 12 hrs) - LMWH injected s/c or HEPARIN IV or fondaparinux
When to give
PCI
Within 120 mints of MI
Within what time-frame can alteplase be given ?
4.5hrs
Within what time-frame can streptokinase be given ?
12 hrs
Streptokinase
Can the dose be repeated or is it a one off?
1 dose within 4 days as
the drug can become ineffective
CPR
Tx
30 compressions per 2 breaths
Or
100 compressions per minute
Meds:
Adrenaline IV 1 in 1000 every 3-5 mints
Alternative
IV Amiodarone (if ventricular fibrillation)
Stable angina
SE
feels tight, dull or heavy – it may spread to your left arm, neck, jaw or back
is triggered by physical exertion or stress
stops within a few minutes of resting
Sometimes there might be other symptoms, like feeling sick or breathless.
Stable angina
What is it
Chest pain due to poor blood supply to the heart muscles
Stable angina
Tx
GTN
Spray 1-2 Spray s/L
1 tablet s/L
Take one dose ever 5 mints if symptoms don’t get better MAX 3 doses
CALL 999
GTN
Tablet expiry
Special container expired with 8 weeks of opening
Isosorbide Dinitrate (MR)
How to take
Swallow BD ( even if MR)
Can be taken s/L
Stable angina
If GTN (= nitrate) Used how often a week to get long term prophylaxis
Twice or more weekly
Stable angina
Long term
Management
(If using GTN more than twice weekly)
(2)
- BB or CCB
(Rate limiting ccb CI in LVSD and HF) - BB ➕ CCB
( if one or both drugs CI add vascodilator
🟢 ranolazine
🟢 ivabradine (in normal sinus rhythm)
OR NICORANDIL (adults only)
2nd line due to ulcers!
No driving till performance established
Ccb
given in angina list
3
Amlodipine
Nifedipine MR
Felodipine
Stable Angina
Managment
How many drugs max
2
Nitrate
tolerance
problems solved
Don’t use patch at night
Take OD instead of BD
Nitrate
SE
Arrhythmias; asthenia; cerebral ischaemia; dizziness; drowsiness; flushing; headache; hypotension; nausea; vomiting
