acute coronary syndromes Flashcards
what are the 3 different types of acute coronary syndromes?
SUN
stemi
unstable angina
non-stemi
what is NSTEMI?
what is STEMI?
NSTEMI = NON ST ELEVATION myocardial infarction
stemi = st elevation myocardial infarction
what biochemical cardiac marker is measured when a diagnosis of acute coronary syndrome is being made?
troponin
as it is released when heart muscles are damaged
what is the biological cause of acute coronary syndrome?
plaque in arteries causes partial or complete obstruction of artery. causes lack of oxygen and blood supply causing chest pain/ischaemia [angina] which is first sign.
if there is complete obstruction of arteries, lack of oxygen to the heart results in muscle death then myocardial infarction
which of STEMI and NSTEMI is serious?
S- serious stemi
nstemi - not serious
which out of the STEMI and NSTEMI results in complete obstruction of heart arteries and heart muscle necrosis?
stemi =complete obstruction of arteries
nstemi=partial obstruction
what is angina? how can it come about? when do symptoms stop?
not enough blood going through arteries.
caused by exercise/stress
symptoms stop within few mins of resting
what are the symptoms of angina?
shortness of breath
sweating
dizziness
chest pain/tightness/SHARP STABBING PAIN [angina]
stabbing pain that spreads to left arm/jaw/neck/back
nausea
fatigue
which is more dangerous: unstable or stable angina?
unstable angina = unpredictable. more dangerous
stable = predictable.
what are the differences between stable and unstable angina?
stable = symptoms occur during exercise/stress
unstable= symptoms occur whilst resting/ symptoms last longer and are more severe
what drugs are used for UNSTABLE angina / myocardial infarction?
C OSAMA BIN [when you c osama bin, you have a heart attack]
clopidogrel oxygen statin ACE inhibitor metoclopramide aspirin beta blockers LV heparin, morphine, diamorphine nitrates
what is the initial management of acute coronary syndrome?
- pain relief should be given with glyceryl trinitrate [sublingual/buccal] ASAP
- iv opioids eg morphine
- a 300mg loading dose of aspirin asap
- oxygen of needed
- insulin for those with hyperglycaemia [>11mmol/L]
mona [morphine, oxygen, nitrates [GTN], aspirin]
what is the management of STEMI?
- aspirin 300mg
- plus a second antiplatelet: clopidogrel/ticagrelor/prasugrel
- unfractionated heparin for pt with renal impairment
- antithrombin agent for pt with fibrinolysis
what is the management of UNSTABLE ANGINA or NSTEMI?
similar to STEMI
- aspirin 300mg
- second antiplatelet: clopidogrel/prasugrel/ticagrelor
- unfractionated heparin for pt with renal impairment
- antithrombin treatment with fondaparinux
what is the management of STABLE angina that is SHORT TERM?
sublingual glyceryl trinitrate taken before an activity that is known to bring up an attack eg exercise
what is the of long term management of STABLE angina?
- beta blocker 1st line for prevention of chest pain
- if beta blockers are not tolerated, give rate limiting calcium channel blockers [verapamil or diltiazem]
- can give beta blocker and CCB both together if beta blocker alone is not enough to control
- ALL pt must be given low dose aspirin and a statin
- diabetic pt may be given ACE inhibitor
what drugs can be ADDED for long term management of STABLE angina if both beta blockers and ccb are not tolerated?
add either ivabradine, nicorandil or ranolazine
what should be given to patients who have once had NSTEMI, stable and unstable angina as PREVENTION of cardiovascular events?
- give lifestyle advice to reduce risk
- give aspirin, statin, ace inhibitor and beta blockers
what drug should be given to pt with STABLE angina and diabetes?
ACE inhibitors
in patients with unstable angina or NSTEMI, dual antiplatelet is recommended. which drugs should be used and for how long?
aspirin and clopidogrel for 12 months
[prasugrel or ticagrelor can be used if clopidogrel intolerant]
nitrates [eg GTN] are beneficial in angina. how do they work?
work as vasodilators: dilate blood vessels to increase more blood and oxygen to the heart
what are the 3 main forms of sublingual GTN?
tablets
spray
patches
what are the main side effects of nitrates [eg GTN]?
postural hypotension
headache
flushing
how long do the effects of GTN last for?
20-30mins
how often in a week should the GTN spray be used for the GP to request long term prophylaxis instead?
more than twice a week
what is the dose of GTN tablets for PROPHYLAXIS of angina?
take 1 tablet before an activity that will likely cause an angina attack
what is the dose of GTN tablets for TREATMENT of angina?
1 tablet to be taken at 5 min intervals. if symptoms not resolved after 3 doses then medical attention needs to be sought
what is the dose of GTN SPRAY for TREATMENT AND PROPHYLAXIS of angina?
1 or 2 sprays under the tognue
what is the dose of GTN transdermal PATCH for TREATMENT of angina?
one patch to be changed every 24 hours
what are the 3 drugs in the nitrates class?
glyceryl trinitrate
isosorbide monotritrate
isosorbide dinitrate
how many times a day is MR isosorbide mononitrate meant to be taken?
how many a times a day is MR isosorbide dinitrate meant to be taken?
mono = once daily
di = twice daily
what is IV glyceryl trinitrate and iV isosorbide dinitrate used for?
severe symptoms or when sublingual is ineffective
what is the main caution of nitrates?
patients develop tolerance
what are the different ways you can prevent patients developing a tolerance to nitrates? [3]
- take isosorbide mononitrate MR as its once daily and has lower tolerance risk
- for twice daily tablets take the second dose after 6-8 hours instead of 12
- leave patches off for 8-12 hours [usually at bedtime]
what are the 3 strengths of GTN tablets?
300, 500 and 600mcg
what is the storage requirements for sublingual GTN tablets? [4]
supplied in glass containers
no more than 100 tabs in each container
enclosed with foil line cap
no cotton wool
when should you discard GTN tablets after opening?
what abt GTN rectal ointment?
both after 8 weeks
how should a patient take GTN tablets?
sitting down to reduce risk of postural hypotension risk
