Acute Coronary Syndromes 1

Question 1

what is angina pectoris?

Answer 1

reversible ischaemia of heart muscle, narrowing of one or more coronary arteries

Question 2

what is classical angina made worse by?

Answer 2

exercise

Question 3

when are symptoms present in classical and unstable angina?

Answer 3

classical - exercise

unstable - at rest

Question 4

what do patients describe with angina?

Answer 4

central crushing chest pain, radiation to arm, back, jaw possible

Question 5

what is classical angina symptoms relieved by?

Answer 5

rest

Question 6

what are the signs of classical angina

Answer 6

often none, occasionally hyperdynamic circulation (anaemia, hyperthyroidism, hypovolaemia)

Question 7

what investigations are used for angina?

Answer 7

ECG at rest and exercise, elimination of other disease, angiography, echocardiography, isotope studies

Question 8

what segment of the ECG is increasingly depressed as ischaemia increases?

Answer 8

ST segment

Question 9

what are the treatments for angina?

Answer 9

reducing oxygen demands of the heart and increasing oxygen delivery to the tissues

Question 10

how do you reduce oxygen demand of the heart?

Answer 10

reduce afterload (BP), reduce preload (venous filling pressure), correct mechanical issues (valves)

Question 11

how do you increase oxygen delivery to tissues?

Answer 11

dilate blocked/narrowed vessels (angioplasty), bypass blocked/narrowed vessels (coronary artery bypass grafting)

Question 12

what are the non-drug therapies for angina?

Answer 12

explanation of illness (living within limitations)

modify risk factors (stop smoking, graded exercise programme, improve diet/control cholesterol)

Question 13

with angina, what is aspirin used for?

Answer 13

reducing MI risk

Question 14

what drugs are used for hypertension?

Answer 14

diuretics, Ca channel antagonists, ACE inhibitors, B blockers

Question 15

what drugs reduce heart filling pressure/dilate coronary vessels?

Answer 15

nitrates

Question 16

what is the emergency treatment for angina?

Answer 16

GTN spray/tab

Question 17

why is GTN spray administered sublingually?

Answer 17

so it bypasses first pass metabolism

Question 18

what are the two types of surgical therapy for angina?

Answer 18

CABG, angioplasty and stenting

Question 19

what happens in CABG

Answer 19

take new blood vessel and graft onto aorta, this can be veins from the legs and then reversed to turn it into an artery and prevent occlusion by the valves

Question 20

what type of intervention is angioplasty and stenting?

Answer 20

percutaneous (dont need to open patient up)

Question 21

what do you need after angioplasty and stent?

Answer 21

dual platelet therapy

Question 22

describe what happens with angioplasty and stenting?

Answer 22

canula is put in and passed to the problem area, balloon opened up which stretches the artery and squashes the plaque, when the balloon inflates the stent clicks into place

Question 23

what is peripheral vascular disease?

Answer 23

angina of the tissues

Question 24

what is claudication?

Answer 24

pain in limb on exercise

Question 25

how is peripheral vascular disease managed?

Answer 25

in the same way as angina

Question 26

what is the consequences of peripheral vascular disease?

Answer 26

limitation of function, poor wound healing, may lead to tissue necrosis and gangrene