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Arrythmia drugs > Acute coronary syndromes > Flashcards

Acute coronary syndromes Flashcards

1
Q

What can be the causes of chest pain

A

broken rib
collapsed lungs
infection
pulled muscle
ANGINA
MYOCARDIAL INFARCTION

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2
Q

What are the classification of coronary artery disease

A
  1. Chronic ischemic heart disease
    -stable angina
  2. Acute coronary syndromes
    - Unstable angina
    -N-STEMI
    -STEMI
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3
Q

What are the differences between unstable and stable angina, N-STEMI and STEMI

A
  • Stable angina: the atherosclerotic plaque has a strong fibrous cap which prevents it from rupturing. It occludes 70% of the artery. Upon exertion - stable angina is triggered causing ischemia of the endocardial tissue

acute coronary syndromes:

-Unstable angina
The atherosclerotic plaque ruptures, platelets will form on the surface of the plaque. This will cause 90% occlusion of the artery and lead to the ischemia of the endocardial tissue. The unstable angina is triggered upon exertion

-N-STEMI: (Non-ST segment elevation MI)
The atherosclerotic plaque ruptures, platelets will form on the surface of the plaque. This will cause 90% occlusion of the artery and lead to the ischemia of the endocardial tissue for MORE THAN 30 MINUTES- this leads to INFARCTION
(triggered at rest)

-STEMI: (ST segment elevation MI)
The atherosclerotic plaque ruptures, platelets will form on the surface of the plaque. This will cause 100% occlusion of the artery and lead to the ischemia of the endocardial tissue for MORE THAN 30 MINUTES- this leads to INFARCTION
(triggered at rest)

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4
Q

How is ischemic heart disease measured

A
  • Medical history
  • Signs/symptoms
    -ECG
    -Biomarkers
    -Imaging and scans- CT angiography
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5
Q

What are the treatments for Acute STEMI (Acute ST segment elevation myocardial infarction)

A
  1. Pharmacological treatment
    -thrombolytics and fibrolytics: streptokinase, urokinase, tissue plasminogen activators
  2. Surgical Intervention
    -Balloon Angioplasty: using a balloon to stretch open an artery
    -Stent
    - coronary bypass
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6
Q

How does t-PA cause thrombolysis

A

t-PA results in plasminogen activation
Plasminogen converts into plasmin
Plasmin degrades fibrin into fibrin degredation products.

  • t-PA is more like a catalyst
    normally in the body: t-PA is bound to PA-I
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7
Q

How is streptokinase different to t-PA

A
  • Streptokinase is bacterial- possible immune recognition
  • Streptokinase binds to circulating plasminogen not plasminogen associated with fibrin
  • SK is less specific to fibrin
  • SK generates antibodies which may lead to a possible allergic reaction
  • Streptokinase forms a complex that converts additional plasminogen to plasmin
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8
Q

What is the structure of Alteplase

A

structural differences in t-PA affect the mode of action

  1. Kringle domain 1: glycosylation, liver clearance
  2. Kringle domain 2: interacts with t-PA, interaction with Fibrin
  3. Growth factor and finger domain: high affinity for fibrin and low affinity for receptor binding and clearance
    4.Protease domain: proteolytic activity
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9
Q

What are Kringle domains

A

triple looped domains linked by disulphide bonds

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10
Q

What is the structure of Reteplase and how does this enhance the function of t-PA

A
  • Removed kringle 1: reduced liver clearance
  • removed glycosylation: an increased half life
  • Removed growth factor and finger domain: dec binding to fibrin
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11
Q

What is the structure of tenectaplase?

A
  • Modified glycosylation: inc plasma half life
  • 4- Alanine substitutions: inc. affinity for fibrin, increased resistance to PA-1 and reduced systemic plasmin activation
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12
Q

Steps for treating N-STEMI

A
  • ECG
    -Myocardial oxygenation
    -Thrombolysis
  • Baloon angioplasty
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13
Q

What are the PROs& CONs of Angioplasty

A

PROS:
- in 60 mins, there is a 95% rate of recanalisation
- No systemic fibrinolysis
- Reduced rate of death and reinfarction

Cons:
-costly
-requires specialist staff

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14
Q

What are the PROs& CONs of thrombolysis

A

PROS: -In 90 mins, recanalisation rate is 55-60%

CONS:
-Re-occlusion rate is 5-15%
- Risk of Intracranial haemorrhage with mortality rate
- Some patients are contraindicated for fibrinolytics

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15
Q

What is the long term management after a myocardial infarction

A

reduce BMI
Improve diet
blood pressure management
Lipid management
smoking cessation
management of LV dysfunction

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Arrythmia drugs (9 decks)

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