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Y3 TCD CASES > ACS > Flashcards

ACS Flashcards

1
Q

what is angina?

A

discomfort in he chest and surrounding areas (jaw, shoulder, back, arm) caused by myocardial ischaemia. The ischaemia is mostly caused by coronary artery disease

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2
Q

what is the difference between typical and atypical angina?

A

TYPICAL angina is precipitated by physical exertion and relieved by rest or GTN within about 5 minutes. ATYPICAL angina is of increasing frequency / severity occuring during minimal exertion or at rest

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3
Q

what are the risk factors for developing coronary artery disease?

A 
smoking
hypertension
dyslipidaemia
diabetes
age
gender
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4
Q

what investigations would you order if you suspected ACS?

A 
ECG
cardiac troponins
FBC
U + E 
lipid profile
glucose
CXR (if indicated)
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5
Q

what treatments would you give in the acute management of cardiac chest pain?

A

M - morphine 5-10mg
O - oxygen therapy if sats below 90% or breathless
N - nitrates - GTN
A - aspirin loading dose 300mg

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6
Q

when should you prescribe dual anti-platelet therapy in pts with cardiac chest pain?

A

CONFIRMED ACS ONLY

give clopidogrel 300mg or ticagrelor 180mg loading dose (ticag better)

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7
Q

name some alternative causes of raised troponins…

A 
sepsis
severe heart failure
aortic disection
myocarditis
PE
chronic renal failure
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8
Q

what is the definition of a type 1 MI?

A

rise / fall in troponins along with 1 of the following:

  • sx of acute myocardial ischaemia
  • ischaemic ECG changes
  • regional wall abnormalities on ECHO
  • coronary thrombus on CT angio
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9
Q

what is the definition of a type 2 MI?

A

rise / fall in troponins along with evidence of imbalance between myocardial supply and demand UNRELATED TO coronary artery atherosclerosis

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10
Q

name some causes of type 2 MI…

A 
coronary artery vasospasm
coronary emboli (via PFO)
coronary artery disection
bradyarhythmias
respiratory failure + severe hypoxia
LVH
sepsis / hypotension / shock
severe anaemia
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11
Q

describe the sound of an aortic stenosis murmur…

A

ejection systolic murmur - high velocity crescendo

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12
Q

describe the sound of a mitral regurgitation murmur…

A

pan systolic

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13
Q

describe the sound of an aortic regurgitation murmur….

A

early diastolic

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14
Q

describe the sound of a mitral stenosis murmur…

A

mid diastolic

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15
Q

heart sound s1 is caused by the closure of which valves?

A

tricuspid and mitral - indicates start of systole

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16
Q

heart sound s2 is caused by the closure of which valves?

A

aortic and pulmonary - indicates start of diastole

17
Q

what is s3 ‘gallop rhythm’?

A

occurs in diastole when ventricles are filling. indicates LV dilation and hypertrophy, often seen in heart failure

18
Q

explain the concept of physiological splitting of s2…

A

inspiration causes the the aortic valve to close slightly before the pulmonary valve

19
Q

which murmurs are heard loudest during inspiration?

A

right sided murmurs - inspiration increases intrathoracic pressure, increases venous return to right side of heart

20
Q

which murmurs are heard loudest during expiration?

A

left sided murmurs - increase in intrathoracic pressure increases pressure of pulmonary circulation. This forces blood into left atrium

21
Q

sitting forward exacerbates murmurs in which valve?

A

aortic - brings valve closer to chest wall

22
Q

leaning to the left exacerbates murmurs in which valve?

A

mitral - apex closer to chest wall

23
Q

where does aortic stenosis murmur radiate?

A

neck > carotids

24
Q

where does mitral regurgitation murmur radiate?

A

axilla

25
Q

where does aortic regurgitation murmur radiate?

A

LEFT sternal edge (note aortic valve usually auscultated over right sternal edge)

26
Q

where does the pulmonary stenosis murmur radiate?

A

left shoulder / supraclavicular area

27
Q

what are the 3 main types of cardiovascular disease?

A

stroke
coronary heart disease
peripheral arterial disease

28
Q

what advice would you give a patient to relief a bout of angina pectoris?

A

stop what you’re doing and rest
GTN spray - wait 5 minutes
GTN spray - wait another 5 minutes
still in pain? Call 999 after 15 minutes in total

29
Q

what are the major complications following MI?

A

decreased contractility
electrical instability
tissue necrosis

30
Q

what interventions are necessary in the secondary prevention of MI?

A

BRATS acronym

Bisoprolol
Ramipril
Aspirin
Ticagrelor
Statin
31
Q

what lifestyle change advice would you give to a patient post-MI?

A 
DIET - mediterranean
stop SMOKING
reduce ALCOHOL unit content to within guided amounts
increase PHYSICAL
WEIGHT

encourage attendance to cardiovascular rehabilitation clinics

Y3 TCD CASES (15 decks)

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