Acute Coronary Syndromes

Question 1

what are examples of acute coronary syndromes?

Answer 1

• angina

- peripheral vascular disease

Question 2

what is angina pectoris?

Answer 2

reversible ischaemia of the heart muscle (due to narrowing of the coronary artery)

Question 3

what type of angina is made worse by exercise & has no symptoms at rest?

Answer 3

classical angina

Question 4

what type of angina has symptoms at rest?

Answer 4

unstable angina

Question 5

what are the symptoms of classical angina?

Answer 5

• no pain at rest

- central crushing pain caused by certain level of exertion

Question 6

what are the medical signs of classical angina?

Answer 6

Often none!
- occasionally hyperdynamic circulation
(anaemia, hyperthyroidism, hypovolaemia)

Question 7

what investigations are carried out to determine if a patient has angina?

Answer 7

• ECG (resting and exercise)
• Angiography
• Echocardiography
• Isotope studies

Question 8

what is an angiography?

Answer 8

dye is used to look at the patency of the patients arteries

Question 9

what is an echocardiography?

Answer 9

ultrasound is used to look at the function of the heart valves & ventricles

Question 10

what can be seen on the ECG of a patient suffering from angina?

Answer 10

• ST segment elevation

- ST segment depression

Question 11

how does the ST segment alter as ischaemia increases?

Answer 11

ST-segment depression increases

Question 12

what are the two main treatment methods for angina?

Answer 12

• reduce oxygen demands of the heart

- increase oxygen delivery to the tissues

Question 13

how can oxygen demands of the heart be reduced?

Answer 13

• reduce after load/blood pressure
• reduce preload/venous filling pressure
• correct mechanical issues (failing heart valves/septal defects)

Question 14

how can oxygen delivery to the tissues be increased in a patient suffering from angina?

Answer 14

• dilate blocked/narrowed vessels

- bypass blocked/narrowed vessels

Question 15

what is the procedure called when a narrowed vessel is stretched using a balloon?

Answer 15

angioplasty

Question 16

if oxygen to the heart is limited due to blocked vessels, what procedure may be carried out?

Answer 16

coronary artery bypass grafting (CABG)

Question 17

what are some modifiable risk factors that can be altered to treat angina?

Answer 17

• stop smoking
• graded exercise programme
• improve diet/control cholesterol

Question 18

what drug may be given to an angina patient in order to prevent the MI risk?

Answer 18

aspirin

Question 19

what drugs may be used to control hypertension in patients suffering from angina?

Answer 19

• diuretics
• Ca channel antagonists
• ACE inhibitors
• beta blockers

Question 20

what drugs may be used to reduce the heart filling pressure or dilate coronary arteries in an angina patient?

Answer 20

nitrates (short acting and long acting)

Question 21

what immediate treatment can be provided to angina patients?

Answer 21

GTN spray/tab

Question 22

what is the function of GTN spray/tab?

Answer 22

reduced preload of the heart

Question 23

what problem may arise during an angioplasty & stunting procedure?

Answer 23

vessel rupture

Question 24

what causes peripheral vascular disease?

Answer 24

atheroma in the femoral/popliteal vessels

Question 25

what can eventually occur due to peripheral vascular disease?

Answer 25

necrosis/gangrene in lower legs

Question 26

what is infarction of the heart caused by?

Answer 26

coronary artery atheroma/embolism

Question 27

what is infarction of the limbs caused by?

Answer 27

femoral and popliteal atheroma/embolism

Question 28

what is infarction of the brain? wear causes thiss?

Answer 28

- stroke! | - atheroma/embolism in the carotid artery

Question 29

when infarction is expected in a patient, what strategies are carried out to minimise impact?

Answer 29

``` REDUCE tissue loss from necrosis - open blood flow to ischaemic tissue - bypass obstruction PREVENT further episode - aspirin ```

Question 30

what methods may be used to open blood flow to ischaemic tissue?

Answer 30

- thrombolysis | - angioplasty

Question 31

what are the main symptoms and signs of a myocardial infarction?

Answer 31

- crushing chest pain - nausea - pale - sweaty - ‘going to die’ feeling

Question 32

what ECG findings may indicate that a myocardial infarction is the diagnosis?

Answer 32

- STEMI | - NSTEMI

Question 33

what immediate care must be provided if a patient suffers a myocardial infarction in the dental surgery?

Answer 33

- phone ambulance - aspirin!!! - basic life support if required

Question 34

what hospital treatments may be carried out to a patient who is suffering a myocardial infarction up to 3 hours from onset of symptoms?

Answer 34

acute angioplasty and stenting

Question 35

how is an angioplasty carried out?

Answer 35

- catheter inserted through artery (femoral or radial) - moved to site of blockage under x-ray control - balloon inflated to open blockage - metal stent clicks rigid to hold vessel open

Question 36

what hospital treatment may be provided to a patient suffering from a myocardial infarction up to 6 hours from onset of symptoms (late presenting)?

Answer 36

thrombolysis

Question 37

what are some contraindications of thrombolysis treatment?

Answer 37

- any recent blood clots are dissolved (previous surgery etc) - sever hypertension - diabetic eye disease, liver disease, pregnancy

Question 38

what complications may a patient experience due to a MI?

Answer 38

- death! - post MI arrhythmias - heart failure - DVT & pulmonary embolism

Question 39

why may DVT & pulmonary embolism occur to MI patients?

Answer 39

immobility during treatment

Question 40

what drugs may be used to prevent a secondary myocardial infarction?

Answer 40

- aspirin - beta blocker - ACE inhibitor

Question 41

how does an NSTEMI myocardial infarction present on an ECG & what are the troponin levels?

Answer 41

- normal, inverted T waves or ST depression | - elevated troponins

Question 42

how does a STEMI myocardial infarction present on an ECG & in terms of troponin levels?

Answer 42

- hyper acute T waves or ST elevation | - elevated troponin level

Question 43

what is a STEMI myocardial infarction?

Answer 43

complete occlusion of the blood vessel lumen