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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
Q

what are the two aims of angina treatment

A

reduce oxygen demands of the heart

increase oxygen delivery to the tissues

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26
Q

how do we reduce the oxygen demands of the heart

A

reduce afterload

reduce preload

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27
Q

what do we tackle when trying to reduce afterload

A

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

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28
Q

what do we tackle when trying to reduce preload

A

venous pressure - if we reduce venous pressure then less blood coming into the heart so less for the heart to pump out

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29
Q

how do we increase oxygen delivery to the tissues

A

dilate blocked narrowed vessels

bypass blocked/narrowed vessels

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30
Q

how do we dilate blocked narrowed vessels

A

angioplasty stretch the blood vessels to get rid of the narrowing

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31
Q

how do we bypass blocked/narrowed vessels

A

coronary artery bypass grafting

32
Q

what are the non drug therapies for angina

A

explain illness so they can live within limitations

modify risk factors

33
Q

how do we modify risk factors

A

stop smoking
graded exercise program
improve diet/control cholesterol

34
Q

what are the focuses for drug therapy for angina

A

reduce MI risk
lower hypertension
reduce preload/dilate coronary vessels

35
Q

what drug do we use to lower MI risk

A

aspirin

36
Q

what drugs do we use to tackle hypertension

A

diuretics, ca channel antagonists

ace inhibitors, B blockers

37
Q

what drugs do we use to reduce preload and dilate coronary vessels

A

nitrates - short acting and long acting

38
Q

what is used in emergency treatment for angina

A

GTN spray/tablet

short shelf life

39
Q

what are the surgical therapies for angina

A

CABG

Angioplasty & stenting

40
Q

what are the disadvantages of CABG

A

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
Q

what are the advantages and disadvantages of angioplasty and stenting

A

lower risk but lower benefit

risk of vessel rupture during procedure

42
Q

what happens in CABG

A

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
Q

what is angioplasty and stent

A

balloon is placed to stretch the vessel
stent put in to keep it open
it is percutaneous intervention

44
Q

why do we need dual anti platelet therapy with stenting

A

the metal inside the artery could cause a clot

45
Q

what is peripheral vascular disease

A

same as angina but in peripheral arteries so effects peripheral tissues
usually the lower limb

46
Q

what does peripheral vascular disease normally affect

A

lower limbs

47
Q

what happens in peripheral vascular disease

A

atheroma in femoral/popliteal vessels
claudication pain in limbs on exercise
pain is relieved with rest

48
Q

how is peripheral vascular disease managed

A

same way as angina

49
Q

what does peripheral vascular disease result in

A

limitation of function
poor wound healing
tissue necrosis and gangrene

50
Q

what does tissue necrosis and gangrene result in if continuing

A

amputation

51
Q

how do you go from ischemia to infarction

A

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
Q

what happens if the plaque surface/platelets detach

A

they can travel downstream and block vessels meaning no blood flow to that area (infarction)

53
Q

what arteries does an infarction to the heart happen in

A

coronary artery

54
Q

what arteries does an infarction to the limbs happen in

A

femoral and popliteal arteries

55
Q

what arteries does an infarction to the brain happen in

A

carotid arteries

56
Q

what are the different types of myocardial infarction

A 
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
Q

what is a spontaneous myocardial infarction

A

primary coronary event

due to plaque fissure/rupture

58
Q

why can an MI secondary to ischaemia

A

happens due to an increased demand of oxygen or a decreased supply

59
Q

what is the strategy for an infarction

A

reduce tissue loss from necrosis

prevent further episode

60
Q

how do we reduce tissue loss from necrosis

A

open blood flow to ischemic tissue

bypass obstruction

61
Q

how do we open blood flow to ischemic tissue

A

thrombolysis

angioplasty

62
Q

how do we prevent a further episode of infarction

A

risk factor management

aspirin

63
Q

what happens in limb infarction

A

it is a medical emergency - we do thrombolysis or salvage surgery
may result in acute limb necrosis which needs amputation

64
Q

what is a brain infarction

A

a stroke

65
Q

how does a stroke occur

A

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
Q

what are the symptoms and signs of a myocardial infarction

A

pain, nausea, pale, sweaty

67
Q

what are the investigations for a myocardial infarction

A

ECG

68
Q

what are we looking for in the ECG when investigating MI

A

ST segment elevation/T wave abnormalities

69
Q

what do Q waves indicate

A

an OLD MI

70
Q

what are the cardiac enzymes to look out for when investigating MI

A

troponin
creatine kinase
LDH and AST increase

71
Q

what is the primary care for an MI

A

aim to get patient to hospital
analgesia, aspirin and reassurance
BSL if required

72
Q

what is the treatment in hospital for MI

A

primary PCI (acute angioplasty and stenting)
thrombolysis if indicated
drug treatment to reduce tissue damage
prevent recurrence/complications (secondary prevention)

73
Q

what are the complications of myocardial infarction

A 
death
arrythmias
heart failure
ventricular hypo function and thrombosis 
DVT and pulmonary embolism 
complications of thrombolysis
74
Q

how do we prevent another MI

A

risk modification and aspirin
Beta blocker
Ace inhibitors

75
Q

what are the complications we treat

A

heart failure
arrythmias
psychological distress

76
Q

what are the dental aspects in acute coronary syndromes

A

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
Q

What are the contraindications for thrombolysis

A

□ Injury/surgery/IM injection
Severe hypertension, active PUD
Diabetic eye disease, liver disease, pregnancy

BDS2 BAMS Cardiovascular (6 decks)

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