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Dentistry Human Disease > Acute Coronary Syndromes > Flashcards

Acute Coronary Syndromes Flashcards

1
Q

Define stenosis

A

Narrowing of blood vessels

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2
Q

Define vascular occlusion

A

Occlusion of blood vessels

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3
Q

What are the three main outcomes of stenosis?

A
  1. Inadequate oxygen delivery
  2. Cramp in affected tissue/muscle
  3. No residual deficit at first
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4
Q

What does residual deficit mean?

A

Leftover issues that occur due to a condition

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5
Q

What are the three main outcomes of vascular occlusion?

A
  1. No oxygen delivery/tissue death
  2. More severe pain
  3. Loss of function of tissues
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6
Q

Define ischaemia

A

A condition where blood flow (and thus oxygen) is restricted or reduced in a part of the body

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7
Q

define infarction

A

Tissue death or necrosis due to inadequate blood supply to the affected area

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8
Q

What are acute coronary syndromes?

A

Type of coronary heart disease. They are a group of conditions, including STEMI, NSTEMI and unstable angina.

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9
Q

What does NSTEMI stand for?

A

Non- ST elevation myocardial infarction

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10
Q

What occurs during an NSTEMI?

A

Plaque ruptures and thrombus formation causes partial occlusion to blood vessel and the tissues need for oxygen cant be met

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11
Q

What can an NSTEMI lead to?

A

damage to the heart and its ability to pump blood throughout the body

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12
Q

What is a STEMI?

A

The most serious type of MI, where there is long interruption to the blood supply caused by total blockage of the coronary artery

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13
Q

What does STEMI lead to?

A

Transmural infarction (involving the full thickness of the myometrium)

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14
Q

What occurs during unstable angina?

A

The plaque ruptures and thrombus forms causing partial occlusion of blood vessel. Angina pain occurs at rest or progresses rapidly over a short period of time.

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15
Q

Why can it be difficult to identify an NSTEMI?

A

This condition doesn’t have an easily identifiable electrical pattern (ST elevation) like other main types of heart attack.

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16
Q

what is the key bio marker used to diagnose a MI?

A

Troponin

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17
Q

Define, reversible ischaemia of the heart muscle

A

Angina

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18
Q

Why does angina occur?

A

Due to narrowing of one or more coronary artery

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19
Q

What are symptoms of angina pectoris

A

Tightness in the chest

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20
Q

What is meant by “classical” angina?

A

Stable angina at rest that worsens with exercise

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21
Q

How would you assess a patient for classical angina?

A

Ask patient how far they can exercise (e.g. ask them to walk up street with gradient) before they experience chest pain

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22
Q

What is meant by “unstable” angina?

A

Chest pain (at rest or active) caused by an insufficient flow of blood and oxygen to the heart due to build up of a clot on surface of atherosclerotic plaque, which narrows the artery

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23
Q

What protein is released into the bloodstream during a heart attack?

A

Troponin

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24
Q

What oral symptoms can occasionally present in a patient suffering from angina?

A

Toothache or aching pain in jaw

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25
Q

What environment can worsen classical angina?

A

Cold weather or feelings of emotion (e.g. stress)

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26
Q

Which type of angina deteriorates over time? Classical or unstable?

A

Classical

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27
Q

True or false?
There are usually signs of classical angina.

A

False, there are often no signs to be seen

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28
Q

What can occasionally be a sign of classical angina?

A

Hyperdynamic circulation

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29
Q

Explain what is meant by hyperdynamic circulation

A

Abnormally increased circulatory volume

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30
Q

What conditions are associated with hyperdynamic circulation?

A
  1. Anaemia
  2. Hyperthyroidism
  3. Hypovolemia (loss of fluid/water)
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31
Q

Explain the effect severe anaemia has on oxygen carrying capacity of blood and the outcome of this

A

Oxygen carrying capacity of blood is reduced and therefore the ability of the patient to cope with narrowing of coronary artery is reduced too.

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32
Q

Explain the effect hyperthyroidism has on the demand of oxygen by tissues and why

A

It increases the demand of oxygen by tissues as it increases the metabolic rate

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33
Q

When carrying out investigations for angina, what should we expect to see from an ECG reading at rest?

A

It can show no change OR an area of myocardial ischaemia

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34
Q

When carrying out investigations for angina, what should we expect to see from an ECG reading during exercise?

A

It will show area of myocardial ischaemia

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35
Q

What are the four investigations used to assess angina?

A
  1. ECG
  2. Angiography
  3. Echocardiography
  4. Isotope studies
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36
Q

An investigation for angina, where a dye is used to look at patency of arteries.

A

Angiography

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37
Q

An investigation for angina, where ultrasound is used to look at function of heart valves and ventricles.

A

Echocardiography

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38
Q

What is the purpose of isotope studies in the investigation of angina?

A

They look at the proportion of blood ejected from the left ventricle

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39
Q

What changes can be expected on an ECG as ischaemia takes place?

A

Usually ST elevation, but occasionally ST depression

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40
Q

What symptom of angina does the ST segment elevation on an ECG correlate with?

A

Pain

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41
Q

what is meant by an “exercise ECG”?

A

Effectively a treadmill test which tests ischaemia of the heart in real time

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42
Q

What might you observe on an angiogram?

A

Coronary artery blockage

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43
Q

What is the proportion of blood flow through a vessel in comparison to the radius of a vessel? And what is the outcome of this?

A

Blood flow through a vessel is proportional to 8 TIMES the radius of a vessel. Therefore for each small reduction in radius, there is a significant reduction in blood flow.

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44
Q

What are the two vital aims of angina treatment?

A
  1. Reduce oxygen demands of the heart
  2. Increase oxygen delivery to the tissues
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45
Q

What are the three ways to reduce oxygen demands of the heart?

A
  1. Reduce afterload
  2. Reduce preload
  3. Correct mechanical issues (failing heart valves, septal defects)
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46
Q

Define, the pressure the heart is having to work against (blood pressure).

A

Afterload

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47
Q

Define, venous filling pressure

A

Preload

48
Q

What is Starling’s law of the heart in simple terms?

A

Increasing the filling pressure of the heart will increase the cardiac work

49
Q

What is the first approach that should be taken for treatment of angina?

A

Reduce oxygen demands of the heart

50
Q

What is the second approach that should be taken for treatment of angina?

A

Increasing oxygen delivery to tissues

51
Q

What are the two treatment options for increasing oxygen delivery to tissues in a patient with angina?

A
  1. Angioplasty
  2. Coronary Artery Bypass Grafting (CABG)
52
Q

What does CABG stand for?

A

Coronary artery bypass grafting

53
Q

What is an angioplasty?

A

Using a balloon to stretch open a narrowed or blocked artery

54
Q

What is normally used in conjunction with an angioplasty?

A

A stent to hold the narrow vessel open

55
Q

What is a common treatment for dealing with persistent narrowing of coronary arteries?

A

CABG

56
Q

When can non-drug therapy for angina be carried out?

A

For those who live within the limitations and are able to modify risk factors

57
Q

What are the three main risk factors to modify in regards to angina?

A
  1. Smoking
  2. Exercise
  3. Diet (control cholesterol)
58
Q

what anti-platelet drug reduces the risk of myocardial infarction?

A

Aspirin

59
Q

How do diuretics treat hypertension?

A

Diuretics help rid the body of sodium and water through passage of urine. The sodium takes water with it from the bloodstream, decreasing the amount of fluid flowing through your blood vessels, hence lowering blood pressure.

60
Q

How do calcium channel antagonists treat hypertension?

A

They relax (vasodilate) blood vessels and the heart muscle receives more oxygenated blood

61
Q

How do ace inhibitors treat hypertension?

A

They prevent an enzyme in the body from producing angiotensin II - a substance that narrows blood vessels- so this helps relax the veins and arteries, lowering blood pressure.

62
Q

How do beta blockers treat hypertension?

A

They cause the heart to beat slower and with less force, therefore lowering blood pressure.

63
Q

what class of drugs can be used to reduce heart filling pressure and dilate coronary vessels?

A

Nitrates

64
Q

Give an example of a nitrate drug that works by relaxing blood vessels and increasing the supply of oxygen to the heart, whilst reducing its workload.

A

Isosorbide

65
Q

What medication must be used in the em,regency treatment of angina?

A

GTN spray

66
Q

what four classes of drugs can be used to treat hypertension?

A
  1. Diuretics
  2. Calcium channel antagonists
  3. Ace inhibitors
  4. Beta blockers
67
Q

What is the function of GTN spray?

A

Relieves pain of angina by reducing preload (opening the coronary arteries and improving blood supply to heart muscle)

68
Q

What does the medication GTN stand for?

A

Glyceryl trinitrate

69
Q

What two forms can GTN medication be administered in?

A

Spray or tablet

70
Q

Where should GTN spray be administered in the mouth?

A

Sublingually

71
Q

Why is GTN spray administered sublingually?

A

Due to first pass metabolism, so that the drug is absorbed quicker.

72
Q

What is “first pass metabolism”?

A

A phenomenon of drug metabolism at a specific location in the body which leads to a reduction in concentration of the active drug before it reaches the site of action or systemic circulation

73
Q

True or false?
CABG can be carried out more than once.

A

False, CABG can only be carried out once. It is a major surgery with mortality risk.

74
Q

What individuals have a decreased outcome/benefit from CABG?

A

Individuals who smoke

75
Q

what is the risk during angioplasty procedure?

A

Vessel rupture

76
Q

In CABG,if veins are used for grafting, why must the be reversed before placed?

A

So to prevent occlusion of blood valves present in veins

77
Q

When is CABG not possible?

A

If there is narrowing along the whole length of an eatery OR if the occlusion is closer to the end of the artery

78
Q

Where must narrowing of an artery be in order for CABG to be a viable option?

A

Near the origin of the artery

79
Q

What issue can arise regarding blood platelets and the stents used in angioplasty procedure?

A

Blood platelets can stick to the stents metal surface

80
Q

How can sticking of blood platelets to stent be reduced?

A

By coating the stent in chemical which will inhibit platelet adhesion or use of anti-platelet drugs

81
Q

Where does peripheral vascular disease most commonly present and why?

A

The leg arteries, which are further from the heart, don’t receive enough blood flow to keep up with demand.

82
Q

what is another word for plaque?

A

Atheroma

83
Q

what is the main sign of peripheral vascular disease?

A

Claudication pain in limb upon exercise

84
Q

In peripheral vascular disease, as atherosclerosis worsens and narrowing of lumen becomes more pronounced, what happens to claudication distance?

A

It reduces and patient will experience pain much quicker

85
Q

True or false?
Atherosclerosis tends to occur around areas of turbulent blood flow, such as where blood vessels branch.

A

True

86
Q

why is poor wound healing associated with peripheral vascular disease?

A

Due to less oxygen delivery to the tissues, so less ability to deliver oxygen and defence cells to area of injury.

87
Q

what can poor wound healing, in peripheral vascular disease, lead to?

A

Necrosis and gangrene

88
Q

Explain what is meant by gangrene

A

Loss of blood supply causing body tissues to die

89
Q

What would be the result of necrosis or gangrene of tissues?

A

Amputation

90
Q

When plaque detached and travels downstream to block other blood vessels

A

Embolism

91
Q

How long does it take for lack of blood flow to cause tissue death?

A

20 minutes

92
Q

What determines the degree of functional loss following MI?

A

The amount of tissue which is infarcted

93
Q

What is an embolic stroke?

A

When platelets and clots detach from atherosclerotic plaque in the d arteries and embolise upwards into the cerebral circulation (brain)

94
Q

In what position to the blockage, is the tissue that will be lost during MI?

A

Any tissue distal to blockage

95
Q

Define, the use of drugs to dissolve the blood clot which is causing blockage in blood vessel

A

Thrombolysis

96
Q

What does TIA stand for?

A

Transient ischaemic attack

97
Q

What is simpler term for TIA?

A

A mini stroke

98
Q

A stroke of short duration (<24hrs) is known as what?

A

Transient ischaemic attack

99
Q

In what way is cardiac pain communicated to the brain?

A

Goes through thalamus and the ancient basal brain tissues to reach the cortex

100
Q

what is a silent myocardial infarction?

A

Where an individual does not feel any pain symptoms and does not know they have had an MI

101
Q

On an individual who has had a previous MI, what what feature of ECG would appear larger?

A

Q wave

102
Q

Define, the heart stops beating, so there is no cardiac output and therefore most likely results in death.

A

Cardiac arrest

103
Q

What equipment should be used in case of cardiac arrest?

A

A defibrillator

104
Q

Within what time period does angioplasty and stunting need to occur after onset of MI to prove most effective?

A

Up to 3 hours

105
Q

What is the “penumbra”?

A

The area of tissue surrounding the ischaemic event

106
Q

What two drugs are most likely to be used in thrombolytic treatment?

A
  1. Streptokinase
  2. Tissue plasminogen activator
107
Q

what treatment is most appropriate to reduce tissue loss from necrosis after delayed admission (upon to 6 hours after symptoms)?

A

Thrombolysis

108
Q

What are the contraindications of thrombolysis and why?

A
  1. If the patient has undergone injury/surgery (includes dental extraction)/Intra muscular injections, as recent blood clots would be dissolved.
  2. Severe hypertension or peptic ulcer disease as this would exacerbate active bleeding
  3. Diabetic eye disease, liver disease and pregnancy
109
Q

Death during MI is usually due to what?

A

A sudden arythmia

110
Q

Define, the restoration of blood flow to an organ or tissue after having been blocked.

A

Reperfusion

111
Q

What are the five main complications of MI?

A
  1. Death
  2. Post MI arrhythmias
  3. Heart failure
  4. Ventricular hypofunction and mural thrombosis
  5. DVT and pulmonary embolism
112
Q

Post MI treatment, what is the main concern within the first few hours?

A

Arrhythmias

113
Q

why may ventricular hypofunction and mural thrombosis occur as a complication of MI?

A

Due to papillary muscle rupture which may lead to valve disease

114
Q

Why might deep vein thrombosis and pulmonary embolism be a complication of MI?

A

Due to immobility during treatment

115
Q

What drugs could be administered to prevent another MI from occurring?

A

1.aspirin
2. Beta blocker
3. ACE inhibitor

Dentistry Human Disease (29 decks)

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