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BDS3 Human Disease > Acute coronary Syndromes > Flashcards

Acute coronary Syndromes Flashcards

1
Q

What are risks of CVD?

A

smoking
hypertension
hypercholesterolaemia (high cholesterol)
diabetes
obesity
male sex
family history of early coronary artery disease
ethnicity
social deprivation

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2
Q

Why have death rates due to CVD declined?

A

fewer people smoking

screening and treatment for other CV risk factor

improved treatments for CV disease

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3
Q

statins do what?

A

a group of medicines that can help lower the level of low-density lipoprotein (LDL) cholesterol in the blood

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4
Q

What are modofiable risk factors?

A

smoking
hypertension
hypercholesterolaemia (high cholesterol)
diabetes
obesity

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5
Q

What are non-modifiable risk factors?

A

male sex
family history of early coronary artery disease
ethnicity
social deprivation

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6
Q

What are 3 types of symptoms for CVD?

A

stable (stable angina)

ACS - acute coronary symptoms

atypical/non-cardiac symptoms

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7
Q

What are stable symptoms of CVD?

A

chest pain/tightness on exertion - reproducible

may radiate to either arm or jaw - small minority of pts may think they have dental disease

often described as dull, heavy, tight, pressure, indigestion

angina equivalent - often breathlessness. much less specific

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8
Q

What is CVD stable symptoms described as?

A

often described as dull, heavy, tight, pressure, mistake for indigestion

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9
Q

What is angina equivalent?

A

often breathless

don’t have typical symptoms

hard to know whether it is the heart

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10
Q

What symptoms are more severe stable or ACS?

A

acute coronary symptoms

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11
Q

Describe the symptoms for ACS?

A

Chest pain/tightness, persisting at rest at rest or onset after very minimal exertion

pain is not always severe, especially in NSTEM (non-stem)

associated symptoms - nausea, vomiting, sweating, breathless

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12
Q

What are symptoms of ACS?

A

nausea, vomiting, sweating, breathless

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13
Q

Are pts undergoing cardiac arrest always in severe pain?

A

not always

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14
Q

What are the atypical/non-cardiac symptoms?

A

sharp pain - can locate a specific location

pain localised to small area of the thorax

worse on inspiration

chest wall tenderness/pain worse on movement

syncope (blackouts)

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15
Q

with regards to atypical pain, what do you call pain on inspiration?

A

Pleuromeia

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16
Q

What is the disease that CVS pts have?

A

atherosclerosis

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17
Q

Describe atherosclerosis?

A

blood vessel = 3 layers

endothelium gets damaged e.g. high blood sugar, diabetes, smoking

now lipids get into the wall of the vessel and for a plaque - atherosclerotic plaque (yellow)

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18
Q

Describe atherosclerotic plaque?

A

lipids at the core and fibrous coating around the outside

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19
Q

In stable coronary disease, what is the atherosclerotic plaque formation like?

A

gradual - the artery becomes gradually more narrowed

ischemia of myocardial tissue and cardiac arrest

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20
Q

In unstable coronary disease, what is the atherosclerotic plaque formation like?

A

more sudden

often an area with mild plaque - the fibrous cap over the top ruptures open

lipid core exposed to blood

then a cascade of platelet activation - thrombus form on top and blocks artery and causes sudden chest pain at rest

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21
Q

What happens if the thrombus completely blocks the artery?

A

causes ST-elevation myocardial infarction (STEMI)

an event in which transmural myocardial ischemia results in myocardial injury or necrosis

LESS SEVERE HEART ATTACK

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22
Q

What is STEMI?

A

an event in which transmural myocardial ischemia results in myocardial injury or necrosis

ST-elevation myocardial infarction (STEMI)

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23
Q

3 types of acute coronary syndrome?

A

STEMI

Non-STEMI

unstable angina

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24
Q

symptoms of STEMI?

A

chest pain

ST elevation on ECG

rise in troponin

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25
Q

symptoms of non-STEMI?

A

chest pain

no ST elevation on ECG

rise in troponin

26
Q

symptoms of unstable angina?

A

unstable chest pain

no ST elevation on ECG

no rise in troponin

27
Q

What is angina?

A

Angina is where you have attacks of chest pain caused by reduced blood flow to your heart.

28
Q

What is cardiac troponin?

A

troponin T and I are cardiac regulatory proteins that control calcium mediated interaction between actin and myosin

29
Q

2 types of cardiac troponin?

A

T and I

30
Q

What does elevated troponin mean?

A

serum levels indicate myocardial damage

31
Q

What can you do if a pts history is suggestive of MI?

A

serum troponin is used to either confirm or exclude the diagnosis

32
Q

Can cardiac troponin be elevated due to other reasons other than MI?

A

YES

33
Q

What are the 3 parts of an ECG to be aware of?

A

P wave

QRS complex

T wave

34
Q

What does the P wave highlight on ECG?

A

atrial depolarisation

= contraction

35
Q

What does the QRS complex highlight on ECG?

A

ventricular depolarisation

36
Q

What T indicate on the ECG?

A

ventricular repolarisation

37
Q

What does ST elevation mean?

A

ST segment is elevated

38
Q

Normal or not normal ECG?

A

NORMAL

P wave

QRS complex

T wave

39
Q

What is the name of the line the arrow is pointing to?

A

isoelectric line

40
Q

Normal or not normal ECG?

A

NOT NORMAL

person having a STEMI

41
Q

How can you tell this person is having a STEMI?

A

first column - THE SEGEMBNT ABOVE THE ISOELECTRIC LINE

artery in heart is blocked

42
Q

What is VF?

A

a type of irregular heart rhythm (arrhythmia)

VENTRICULAR FIBRILATION

unorganised electrical activity

43
Q

What does VF always cause?

A

MI

pt usually unconscious

44
Q

What is the treatment for VF?

A

CPR + DC cardioversion (ALS algorithm) from defibrillator

45
Q

Medications to treat ACS?

A

Aspirin - antiplatelet

other antiplatelet drugs - clopidogrel, ticagrelor, prasugrel

statins

ACE inhibitors

MRA - mineralocortocoid receptor antagonists

beta-blocker

46
Q

What do the alternative antiplatelet drugs act upon?

A

P2Y12 receptor inhibitor

47
Q

Does aspirin or the alternative antiplatelet drugs have a higher risk of bleeding?

A

the alternative antiplatelet drugs

clopidogrel, ticagrelor, prasugrel

48
Q

Why are statin prescribed for ACS?

A

inhibit the production of LDL from the liver - BAD CHOLESTEROL

49
Q

Examples of statins?

A

atorvastatin, rosuvastatin, simvastatin

50
Q

Why are ACE prescribed used for ACS?

A

ramipril

perindopril

lisinopril

51
Q

What drug is used to treat pts with heart failure after MI?

A

mra - mineralocorticoid receptor antagonists

52
Q

What beta-blockers are prescribed for ACS?

A

bisoprolol

atenolol

metoprolol

53
Q

Why prescribe beta blockers for ACS?

A

are drugs used to treat angina, lower blood pressure, protect against recurrent heart attacks

prevent VF

54
Q

What is an alternative to medications for ACS?

A

revascularisation

55
Q

What are to ways to achieve revascularisation for ACS?

A
  1. percutaneous coronary intervention (PCI)
  2. Coronary artery bypass surgery (CABG)
56
Q

What is PCI?

A

small metal cage delivered on a wire in the artery

it squashes the plaque out the way

allows blood flow down the artery

57
Q

What is CABG?

A

2 ways:

harvesting a vein form the leg - stitching it on to the aorta and to the coronary artery beyond the narrowing - restoring the blood flow

using arteries within the chest wall - can be used as well

58
Q

CABG vs PCI?

A

CABG doesn’t do anything directly to the plaque causing the blockage

59
Q

When is the bypass sugery good to use?

A

when a pt has 2 or more major coronary arteries affected or left main stem stenosis

and diabetic

60
Q

What is DAPT?

A

dual antiplatelet therapy

= aspirin with one of the other ACS drugs

61
Q

What does ST elevation indicate?

A

occurs due to occlusion of one or more coronary arteries, causing transmural myocardial ischemia which in turn results in myocardial injury or necrosis.

BDS3 Human Disease (15 decks)

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