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Cardiovascular > Acute Coronary Syndrome > Flashcards

Acute Coronary Syndrome Flashcards

1
Q

What are the 3 types of ACS

A

Unstable angina
STEMI
NSTEMI

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2
Q

What are acute coronary syndromes

A

When the heart isnt getting enough blood and so gets less oxygen causing angina

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3
Q

How to diagnose ACS

A

ECG, biochemical markers -troponin

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4
Q

Whats troponin

A

Released in the blood when your having an MI

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5
Q

Whats the difference between STEMI and NSTEMI

A

STEMI is a full blown heart attack whereas NSTEMI is when the heart is partially blocked

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6
Q

How do you differentiate a STEMI and NSTEMI on an ECG

A

STEMI has an elevated ST segment which is a sign of a full blown heart attack

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7
Q

Causes of ACS

A

Plaques obstruct blood in artery (partial or complete)

Lack of oxygen to the heart (angina)

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8
Q

Whats the first sign of a heart attack

A

Angina

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9
Q

Whats an MI

A

When the heart muscle begins to die (necrosis) due to extensive obstruction of blood flow

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10
Q

Angina symptoms

A

Chest pain (stabbing, dull, tight, heavy)
Travelling pain to jaw, neck, left arm and back

SOB
Sweating
Fatigue
Dizziness
Nausea

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11
Q

Whats the difference between stable and unstable angina

A

Stable occurs during exercise/ stress and relieved at rest

Unstable occurs while resting, lasts longer and more occurring. Severe chest lain

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12
Q

Whats used for stable angina acute attacks (before exercise)

A

Sublingual GTN

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13
Q

Whats the long term prevention of ACS

A
  1. BB or CCB
  2. BB + CCB
  3. Replace BB or CCB with long acting nitrate, ivabradine, nicorandil, ranolazine

And secondary prevention of CVD

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14
Q

If BB and CCB are contraindicated in a patient what would you recommend as 1st line

A

Long acting nitrate, ranolazine, ivabradine, nicorandil

They can be given as monotherapy but if 2 drugs fail to control angina refer to specialist

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15
Q

Whats the secondary prevention of CVD used in ACS

A

Lifestyle
Acei + BB (can give diltiazem or verapamil if CI)

Statin - atorvastatin 80mg

Low dose Aspirin -75mg + clopi for 12 months
- if high cardiac biomarkers - triple (aspirin, clopi, rivaroxaban)

ACEi especially in diabetics

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16
Q

BB cant be given with _____ because of heart block

A

Verapamil

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17
Q

Whats the initial management of ACS

A

GTN sublingual/ buccal ASAP - pain relief
Aspirin 300mg ASAP

Oxygen - if needed
IV opioids - morphine if severe pain
Insulin - if hyperglycaemic : glucose >11mol/l

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18
Q

Initial management in STEMI

A

Aspirin 300mg + clopidogrel/ticagrelor/prasugrel

Heparin (unfractionated) for sig renal impairment

Antithrombin for fibrinolysis patients

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19
Q

Initial management in unstable angina

A

Aspirin 300mg + ticagrelor/prasugrel/clopidogrel

Fondaparinux sodium

Heparin (unfractionated) for sig renal impairment

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20
Q

Aspirin cautionary and advisory labels

Normal
Dispersible
G/R

A

Take with or just after food

This product contains aspirin dont take any other product with aspirin whilst taking this medicine

Dispersible:
Dissolve or mix with water before taking

G/R
Swallow whole. Do not chew or crush.
Dont take indigestion remedies 2 hours before or after you take this medication

21
Q

Can aspirin 300mg tablets be chewed

A

Normal tablets
Not G/R

22
Q

When would you use triple anticoagulant therapy in secondary prevention of CVD

A

If they have high cardiac biomarkers

23
Q

Which DOAC is the only one used in ACS secondary prevention of CVD?
Dose?

A

Rivaroxaban
2.5mg BD

24
Q

What formulations do nitrates come in

A

Sprays
Tablets
Patches

25
Q

Nitrates MOA

A

Vasodilator and reduces venous return which reduces left ventricular work

26
Q

Common SE of nitrates

A

Flushing
Throbbing headache
Postural hypotension

27
Q

Nitrates onset and duration of action

A

Onset is rapid but relief lasts 20-30 mins

28
Q

When is long term prophylaxis required in angina

A

When GTN is used more than twice a week

29
Q

A patient is using GTN for their acute attacks. They are using it 4x a week. What do you do

A

If theyre using it more than twice a week long term prophylaxis is required which includes

  1. BB or CCB (amlodipine, verapamil etc.)
  2. BB + CCB
  3. Replace ccb or bb with ivabridine, nicorandil, ranolazine or long acting nitrate
30
Q

Whats the advantage and disadvantage of transdermal GTN

A

Prolonged action

But tolerance may develop

31
Q

When is GTN used as an ointment

A

Rectal fissure to relieve pain

32
Q

How do you use GTN tablets for prophylaxis of angina

A

1 tablet before activity likely to cause angina

33
Q

How do you use GTN tablet/spray for treatment of angina

A

1 tablet/spray repeated at 5 mins intervals if required. If symptoms not resolved after 2 doses call 999

34
Q

GTN spray for angina prophylaxis how do you use

A

1-2 sprays under tongue before activity likely to cause angina

35
Q

GTN patches for prophylaxis of angina

A

1-2 every 24 hrs

36
Q

Available strength of GTN sublingual tablets

A

300mg
500mg
600mg

37
Q

What kind of container should the GTN sublingual tabs be supplied in

A

Glass containers closed with a foil line cap
No cotton wool wadding

38
Q

Discard GTN sublingual tabs …….. after opening

A

8 weeks

39
Q

Discard GTN rectal ointment ……. After opening

A

8 weeks

40
Q

What position do you take GTN in and why

A

Sitting down to prevent postural hypotension

41
Q

Whats the difference between isorsobide mononitrate and dinitrate

A

Mononitrate is given OD whereas dinitrate can be given 2-3x a day

Dinitrate is broken down into mononitrate and then absorbed by the body

42
Q

MR isorsobide dinitrate duration of action

A

12 hours

43
Q

Are MR preps of isorsobide mononitrate available and what are they licensed for

A

Yes

Angina prophylaxis

44
Q

When are IV GTN or IV isorsobide dinitrate used

A

For more severe symptoms when sublingual form is ineffective

45
Q

Main caution of nitrates

A

Tolerance

46
Q

How do you reduce tolerance in nitrates tablets

A

Take MR isorsobide OD

For BD, take second dose after 6-8 hours not 12 hours

47
Q

How do you reduce tolerance in nitrate patches

A

Leave patch off for 8-12 hours (usually overnight) in each 24hrs

48
Q

Isorsobide dinitrate onset of action

A

Slow

49
Q

Isorsobide mononitrate and tadalafil interaction

A

Increases risk of hypotension

Cardiovascular (9 decks)

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