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BDS2 BAMS Cardiovascular > Acute Coronary Syndromes > Flashcards

Acute Coronary Syndromes Flashcards

1
Q

what are the two processes for acute coronary syndromes

A

blood vessel narrowing

blood vessel occlusion

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2
Q

what happens in blood vessel narrowing

A

radius of the vessel is decreased so there is a large restriction on blood flow therefore there is inefficient oxygen delivery
when demand increases the blood flow cannot increase resulting in muscles going through aerobic respiration resulting in the production of lactic acid

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3
Q

what is the result of blood vessel narrowing

A

cramp in affected tissue/muscle
can cause angina
completely reversible to begin with but overtime will lead to fibrosis of the muscle

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4
Q

what happens in blood vessel occlusion

A

results in no oxygen delivery and cell death
more severe pain
loss of function of the tissue

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5
Q

what is the key to tackling acute coronary syndromes

A

giving effective treatment early

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6
Q

what is looked at in an acute coronary syndrome

A

history
ECG findings
biomarkers

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7
Q

what are the ECG findings relevant to myocardial infarction

A

STEMI

NSTEMI

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8
Q

what is a STEMI

A

ST-segment elevation myocardial infarction

stemi is a full blockage of a coronary artery

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9
Q

what is a NSTEMI

A

non-ST segment elevation myocardial infarction

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10
Q

why is it important to identify if it was a STEMI or NSTEMI

A

they are treated differently

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11
Q

what are the biomarkers used to diagnose ACS

A

troponin

when the cardiac muscle is damaged, troponin is released into the blood and will increase as more tissue is damaged

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12
Q

how can atherosclerosis lead to a blockage in the artery

A

starts off as a fatty streak
builds into plaque
turns into obstructive atherosclerotic plaque - causes angina
plaque fissure erosion results in thrombosis blocking the artery

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13
Q

what are the 3 coronary arteries

A

circumflex coronary artery
left coronary artery
right coronary artery

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14
Q

when does blood flow to the coronary arteries happen and why

A

during diastole as during systole the aortic valve is open and covers the opening to the coronary arteries

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15
Q

what is angina pectoris

A

reversible ischaemia of the heart muscle due to narrowing of one or more coronary arteries
two types

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16
Q

what are the two types of angina

A

classical

unstable

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17
Q

what is classical angina

A

worsens with exercise

goes away at rest

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18
Q

what is unstable angina

A

presence of symptoms at rest with no biomarkers

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19
Q

what is the pain of angina described as

A

central crushing chest pain
may radiate to arm, back and jaw
can be more commonly felt on the left side due to the left side forming most of the aorta and artier of head and neck

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20
Q

what are the symptoms of classical angina

A 
no pain at rest
pain with certain level of exertion - worse with cold water/emotion
pain relieved by rest
patient lives within limits of tolerance
gradual deterioration
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21
Q

what are the signs of classical angina

A

often none as patients will not push themselves enough to get pain
occasionally hyperdynamic circulation

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22
Q

what are the investigations for angina

A 
ECG at rest and exercise
eliminating other diseases such as thyroid diseases, anemia and valve disease 
angiography 
echocardiography 
isotope studies (function assessment)
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23
Q

what is an angiography

A

die injected into artery to see if it is narrowing

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24
Q

what is an echocardiography

A

ultrasound - see if there is changes in blood flow

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25
what are the two aims of angina treatment
reduce oxygen demands of the heart | increase oxygen delivery to the tissues
26
how do we reduce the oxygen demands of the heart
reduce afterload | reduce preload
27
what do we tackle when trying to reduce afterload
blood pressure as if there is a higher blood pressure than this means there is more pressure in the ventricles to squeeze the blood out if we reduce blood pressure then we reduce the pressure the heart pumps blood out at
28
what do we tackle when trying to reduce preload
venous pressure - if we reduce venous pressure then less blood coming into the heart so less for the heart to pump out
29
how do we increase oxygen delivery to the tissues
dilate blocked narrowed vessels | bypass blocked/narrowed vessels
30
how do we dilate blocked narrowed vessels
angioplasty stretch the blood vessels to get rid of the narrowing
31
how do we bypass blocked/narrowed vessels
coronary artery bypass grafting
32
what are the non drug therapies for angina
explain illness so they can live within limitations | modify risk factors
33
how do we modify risk factors
stop smoking graded exercise program improve diet/control cholesterol
34
what are the focuses for drug therapy for angina
reduce MI risk lower hypertension reduce preload/dilate coronary vessels
35
what drug do we use to lower MI risk
aspirin
36
what drugs do we use to tackle hypertension
diuretics, ca channel antagonists | ace inhibitors, B blockers
37
what drugs do we use to reduce preload and dilate coronary vessels
nitrates - short acting and long acting
38
what is used in emergency treatment for angina
GTN spray/tablet | short shelf life
39
what are the surgical therapies for angina
CABG | Angioplasty & stenting
40
what are the disadvantages of CABG
benefit not always obtained major surgery so has a higher mortality risk limited benefit of 10 years and less in smokers who continue to smoke
41
what are the advantages and disadvantages of angioplasty and stenting
lower risk but lower benefit | risk of vessel rupture during procedure
42
what happens in CABG
we take a vein from the patients leg and sew it to the aorta It diverts blood around narrowed or clogged parts of the major arteries to improve blood flow and oxygen supply to the heart.
43
what is angioplasty and stent
balloon is placed to stretch the vessel stent put in to keep it open it is percutaneous intervention
44
why do we need dual anti platelet therapy with stenting
the metal inside the artery could cause a clot
45
what is peripheral vascular disease
same as angina but in peripheral arteries so effects peripheral tissues usually the lower limb
46
what does peripheral vascular disease normally affect
lower limbs
47
what happens in peripheral vascular disease
atheroma in femoral/popliteal vessels claudication pain in limbs on exercise pain is relieved with rest
48
how is peripheral vascular disease managed
same way as angina
49
what does peripheral vascular disease result in
limitation of function poor wound healing tissue necrosis and gangrene
50
what does tissue necrosis and gangrene result in if continuing
amputation
51
how do you go from ischemia to infarction
you get an atheroma in vessels the plaque ulcerates resulting in platelet aggregation and thrombosis on the surface thrombosis can enlarge rapidly to block the vessel
52
what happens if the plaque surface/platelets detach
they can travel downstream and block vessels meaning no blood flow to that area (infarction)
53
what arteries does an infarction to the heart happen in
coronary artery
54
what arteries does an infarction to the limbs happen in
femoral and popliteal arteries
55
what arteries does an infarction to the brain happen in
carotid arteries
56
what are the different types of myocardial infarction
``` spontaneous MI secondary to ischemia sudden death with symptoms of ischaemia and evidence of ST elevation or thrombus MI from PCI MI from CABG ```
57
what is a spontaneous myocardial infarction
primary coronary event | due to plaque fissure/rupture
58
why can an MI secondary to ischaemia
happens due to an increased demand of oxygen or a decreased supply
59
what is the strategy for an infarction
reduce tissue loss from necrosis | prevent further episode
60
how do we reduce tissue loss from necrosis
open blood flow to ischemic tissue | bypass obstruction
61
how do we open blood flow to ischemic tissue
thrombolysis | angioplasty
62
how do we prevent a further episode of infarction
risk factor management | aspirin
63
what happens in limb infarction
it is a medical emergency - we do thrombolysis or salvage surgery may result in acute limb necrosis which needs amputation
64
what is a brain infarction
a stroke
65
how does a stroke occur
it is usually an embolism from atheroma occasionally can be a cerebral bleed very rarely vessel thrombosis as there is a good collateral blood supply (left/right, vertebral)
66
what are the symptoms and signs of a myocardial infarction
pain, nausea, pale, sweaty
67
what are the investigations for a myocardial infarction
ECG
68
what are we looking for in the ECG when investigating MI
ST segment elevation/T wave abnormalities
69
what do Q waves indicate
an OLD MI
70
what are the cardiac enzymes to look out for when investigating MI
troponin creatine kinase LDH and AST increase
71
what is the primary care for an MI
aim to get patient to hospital analgesia, aspirin and reassurance BSL if required
72
what is the treatment in hospital for MI
primary PCI (acute angioplasty and stenting) thrombolysis if indicated drug treatment to reduce tissue damage prevent recurrence/complications (secondary prevention)
73
what are the complications of myocardial infarction
``` death arrythmias heart failure ventricular hypo function and thrombosis DVT and pulmonary embolism complications of thrombolysis ```
74
how do we prevent another MI
risk modification and aspirin Beta blocker Ace inhibitors
75
what are the complications we treat
heart failure arrythmias psychological distress
76
what are the dental aspects in acute coronary syndromes
emergency management risk assessment - is this patient going to have an MI, angina attack, sudden cardiac death, stroke etc dentists have a role in promoting good health
77
What are the contraindications for thrombolysis
□ Injury/surgery/IM injection Severe hypertension, active PUD Diabetic eye disease, liver disease, pregnancy

BDS2 BAMS Cardiovascular (6 decks)

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