Acute Coronary Syndrome and Myocardial Infarction Flashcards
Define stable angina
Where the patient will have angina on exertion only
Define unstable angina
Where the patient will have angina at rest
What form of angina is unpredictable and often leads to MI
Unstable angina
What are the two types of myocardial infarction ?
Non-ST elevated myocardial infarction
ST elevated myocardial infarction
What causes a NSTEMI ?
This will occur if a coronary artery is partially occluded and often follows unstable angina.
What causes a STEMI ?
This will occur if a coronary artery is completely occluded and can follow on from a NSTEMI
What specific pathology can cause a STEMI and what factors can cause this?
Plaque rupture
Inflammation and stress
What type of clinical indications would you look for in past medical history ?
Smoker/ex-smoker Diabetes Hyperlipidaemia Previous angina Strong family history of heart disease
What bio-marker can be found in the patient’s blood which will indicate cardiac stress or an MI ?
Troponin (cTn)
What else can cause Troponin to be found in the blood stream ?
Sepsis
Where is Troponin found within the heart ?
Troponin can be found on the thin filaments within the myocytes
In a STEMI what is most likely to occur in the tissue of the heart ?
Infarct/myocyte death
What complications are likely to arise post MI ?
Mechanical complications
Ventricular arrhythmia complications
What type of mechanical issues can arise post MI ?
Wall rupture
Inter-ventricular septum rupture
Papillary muscle rupture
What type of Ventricular arrhythmia complications can occur ?
Ventricular tachycardia
Ventricular fibrillation
Describe the mechanism of action of thrombolytic therapy
Works to breakdown the thrombus
Turns Plasminogen into plasmin which breaks down the fibrin and fibrin in the clot.
What are the two types of Fibrinolytic agents ?
Specific Fibrinolytic agents
Non-specific fibrinolytic agents
Name 3 fibrin specific agents
1: Alteplase
2: Reteplase
3: Tenecteplase
When would thrombolytic therapy be used ?
When PCI not suitable or outwith the time-frame for PCI
What is the benefit of aspirin in patients with ischaemic heart disease ?
Aspirin inhibits platelet production (specifically inhibiting Thromboxane A2)
What is the immediate first line treatment for those who present with NSTEMI ?
ABCDE and then MONA Morphine Oxygen Nitroglycerine Aspirin
How does Clopidogrel treat ischaemic heart disease ?
Much like aspirin Clopidogrel will inhibit platelet synthesis:
Blocking the ADP recepto
Also irreversibly inhibits P2Y12 ADP which is key to platelet aggregation and crosslinking with fibrin.
What is the name of the pathway that is blocked by Clopidogrel ?
GP IIb/IIIa pathway.
Name 4 types of low molecular weight Heparin
1: Enoxaparin
2: Dalteparin
3: Tinzeparin
4: Fondaparinux
How do Beta Blockers treat ischaemic heart disease ?
They competitively inhibit the effects of catecholamines on the heart which will lower heart rate and blood pressure and also myocardial contractility.
