ACUTE CORONARY SYNDROMES

Question 1

Angina symptoms

Answer 1

tightness/ crushing feeling in chest

Question 2

Angina cause

Answer 2

Narrowing of coronary arteries so require more O2 from cardiac muscle

Question 3

Diseases that precipitate angina

Answer 3

Anaemia
Hyperthyroidism

Question 4

Angina investigations

Answer 4

Exercise ECG
Angiography
Echocardiography
Radioisotope studies

Question 5

Aim of angina tx

Answer 5

reduce O2 demand of the heart - reduce BP afterload, preload and correct mechanical issues (failing valves, septal defects)

Question 6

Non-drug angina therapy

Answer 6

Modify risk factors - stop smoking, exercise, improve diet/ control cholesterol

Question 7

Angina drug therapy

Answer 7

Aspirin

Diuretics
Ca channel antagonists
ACE inhibitors
Beta blockers

Nitrates

Question 8

Emergency angina tx

Answer 8

GTN spray

Question 9

Angina surgical therapy

Answer 9

Coronary artery bypass grafting - veins from legs grafted into aorta and carry blood past obstruction

Angioplasty and stenting - canula in leg/arm, balloon stretch artery - antiplatelets prescribed alongside

Question 10

Peripheral vascular disease

Answer 10

angina of the tissues usually in lower limbs - atheroma in femoral/ popliteal vessels

Question 11

Peripheral vascular disease symptoms

Answer 11

Pain/ anaerobic cramp in limb on exercise

Relived with rest

Poor wound healing

Potential necrosis

Question 12

Myocardial infarction cause

Answer 12

Blood clotting in arteries due to atherosclerosis = no blood flow to area so tissue necroses

Question 13

Types of infarctions

Answer 13

heart - coronary artery atheroma
limb - femoral and popliteal arteries
brain - carotid arteries; embolic stroke

Question 14

MI management

Answer 14

thrombolysis and angioplasty - dissolves clot
CABG, fem/pop bypass - bypass obstruction
risk factor management and aspirin - prevent further episode

Question 15

Carotid artery atherosclerosis results in?

Answer 15

ischaemic stroke

Question 16

MI diagnosis is found through

Answer 16

ECG findings; STEMI, NSTEMI
Biomarker Troponin

Question 17

STEMI vs NSTEMI

Answer 17

STEMI - classic heart attack
NSTEMI - blockage of small artery or partial blockage of main artery

Question 18

Primary care for MI

Answer 18

Analgesia, aspirin
BLS

Question 19

Hospital tx for MI

Answer 19

Acute angioplasty and stenting (up to 3 hours from onset)
Thrombolysis (up to 6 hours from onset)

Question 20

Thrombolysis contraindications

Answer 20

Recent blood clots
severe hypertension
active peptic ulcer disease
diabetic eye disease
liver disease
pregnancy

Question 21

Long term medical management of MI

Answer 21

Prevent next MI - apsirin, B blocker, ACE inhibitor