acute coronary syndromes Flashcards
coronary blood flow to the myocardium may be reduced by mechanical obstruction that is due to …
atheroma, thrombosis, spasm, embolus, coronary postal stenosis, coronary arteritis
what does primary prevention and secondary prevention mean in regards to cardiovascular disease (atherosclerosis)
primary= prevention of the atherosclerotic process secondary= treatment of the atherosclerotic disease process
what drug is recommended in the primary prevention of cardiovascular disease in people with a 10 year risk of cardiovascular disease or 10% higher
Atorvastatin 20mg
in patients with established cardiovascular disease 80mg is recommended
explain classical or typical angina
Characterised by chest pain which is heavy, tight or gripping, central or retrosternal pain may radiate to the jaw. Pain occurs at emotional stress or with exercise. pain eases with rest or with GTN
explain atypical angina
chest pain with 2 out of the 3 features of classical angina.
explain non-angina chest pain
described by NICE as having 1 out of 3 of the features of angina
explain stable angina
Is classified by the Canadian Cardiovascular Society guidelines ie class 1 = no angina with ordinary activity: angina with strenuous activity class 2 = angina during ordinary activity eg walking up hills with mild limitation of activity class 3 = angina with low levels of activity eg walking 50-100m with marked restrictions on activity class 4= angina at rest or with any level of exercise
explain unstable angina
Refers to angina of recent onset (<24hours) or deterioration in previous stable angina, with symptoms frequently occurring at rest: that is acute coronary syndrome
explain refractory angina
Patients with sever coronary disease in whom revascularation is not possible and angina is not controlled by medical therapy
explain vasospastic or variant (Prinzmetals) angina
Angina that occurs without provocation, usually at rest, as a result of coronary artery spasm. it occurs more frequently in women. Characteristically there is ST segment elevation on the ECG during this pain
explain microvascular angina
Patients have exercised induced angina but normal or unobstructed coronary arteries. Intracoronary acetylcholine may cause coronary spasm.
how should stable angina be treated
- information, lifestyle modifications, short acting nitrates, secondary prevention
- beta blocker or calcium channel blocker
3a. If not tolerated then move to long acting nitrates, Ivabradine, Nicorandil, Ranolazine.
3b. if symptomatic switch to the other (ie if using beta blocker switch to calcium channel blocker) or use both a beta blocker and a calcium channel blocker - if symptomatic on 2 anti-anginals consider revascularation
5a. PCI = single vessel disease. multi vessel disease <65years
5b. CABG = unsuitable anatomy. multi vessel >65 years. diabetes
what is the process of percutaneous coronary intervention (PCI) for angina
the process dilates a coronary artery stenosis by introducing an inflatable balloon and metallic stent into the arterial circulation via the femoral, radial or brachial artery
- dual anti platelet therapy should continue for 6-12 months (aspirin and P2Y12 inhibitor)
what is coronary artery bypass grafting (CABG)
autologous veins or arteries are anastomosed to the ascending aorta and to the native coronary arteries distal to the area of stenosis (ie blood bypasses the obstructed area)
explain the factors that influence PCI vs CABG
- PCI is proffered to CABG in patients with single or doubled vessel disease not involving the proximal left anterior descending or left main stem.
- CABG and PCI are both appropriate in patients with proximal LAD stenosis, LMS or three vessel disease and a low SYNTAX score
- CABG is preferred to PCI in patients with three vessel disease and diabetes or elevated SYNTAX (>22) and in patients of a SYNTAX or LMS score of more than 22