Acute coronary syndromes

Question 1

stable angina

Answer 1

pain prompted by exercise and relieved by rest

atherosclerotic plaque narrowing bvs troponin levels = normal and ECG = normal

Question 2

unstable angina

Answer 2

pain can happen at any time 
atherosclerotic plaque with additional clot on surface causing further narrowing 
troponin levels = normal 
ECG = may show depressed ST segments 
difficult to distinguish from MI

Question 3

NSTEMI

Answer 3

No ST elevation MI - may be ST depression or normal
atherosclerotic plaque has clot that either completely or partially occludes vessel
causes subendocardial infarction which affects interior layer of cardiac muscle
troponin levels = elevated

Question 4

STEMI

Answer 4

ST elevated MI
clot forms on plaque that completely occludes vessel
causes transmural infarction meaning full thickness of cardiac muscle is affected
troponin = elevated

Question 5

troponin

Answer 5

biomarker released when cardiac muscle dies (infarction)

Question 6

how long can tissues survive the effects of occlusion for

Answer 6

20 minutes

Question 7

angina pectoris

Answer 7

temporary ischaemia of heart muscle caused by narrowing of at least one coronary artery

Question 8

angiography

Answer 8

dye to look at patency of arteries

Question 9

echocardiography

Answer 9

ultrasound to look at valve and ventricle function

Question 10

what drugs are used to reduce hypertension

Answer 10

ABCD 
ace inhibitors 
beta blockers 
ca channel blockers 
diuretics

Question 11

GTN spray

Answer 11

used to treat angina in emergencys

should be administered sublingually to avoid first pass metabolism

Question 12

CABG

Answer 12

coronary artery bypass grafting

major surgery therefore a mortality risk , can only be performed once, veins taken from leg and grafted into position

Question 13

PCI

Answer 13

percutaneous intervention

angioplasty and stenting

Question 14

angioplasty

Answer 14

used to widen narrowed or obstructed arteries

canulla entered via leg then baloon inflated in desired artery squashing the plaque

Question 15

stenting

Answer 15

done alongside angioplasty

metal framework inserted that stays in place after baloon inflates holding the bv open

Question 16

claudication pain

Answer 16

pain felt in lower limbs when o2 requirements exceed supply

PVD

Question 17

claudication distance

Answer 17

distance patient can walk before feeling pain

PVD

Question 18

gangrene

Answer 18

tissue death due to decreased blood flow or serious infection

Question 19

why can PVD result in poor wound healing and the risk of necrosis and gangrene

Answer 19

PVD = narrowed/ blocked blood vessels causing ischaemia (angina of lower limbs)
this decreased blood flow means less clotting factors and defence cells are delivered to the sites

Question 20

what are the 2 treatment options for myocardial infarction

Answer 20

PCI (angioplasty and stenting)

thrombolysis drugs - dissolve blood clots

Question 21

what drug can be given to prevent a further episode of MI

Answer 21

aspirin

Question 22

stroke

Answer 22

carotidd artery atherosclerosis - clots can embolise up internal carotid artery to the brain

Question 23

transient ischaemic attack

Answer 23

mini stroke
solely platelet clots can be removed by the body fairly quickly , patient may be left with no functional deficit
usually an indicator that patient is at risk of a full storke

Question 24

symptoms of a myocardial infarction

Answer 24

amplified angina symptoms

pale, sweating, nausea, ‘going to die’, sometimes loss of consciousness

Question 25

MI vs cardiac arrest

Answer 25

MI = conscious and chest pain

cardiac arrest = unconscious and no cardiac output