Acute Coronary Syndromes Flashcards
what are examples of acute coronary syndromes?
- angina
- peripheral vascular disease
what is angina pectoris?
reversible ischaemia of the heart muscle (due to narrowing of the coronary artery)
what type of angina is made worse by exercise & has no symptoms at rest?
classical angina
what type of angina has symptoms at rest?
unstable angina
what are the symptoms of classical angina?
- no pain at rest
- central crushing pain caused by certain level of exertion
what are the medical signs of classical angina?
Often none!
- occasionally hyperdynamic circulation
(anaemia, hyperthyroidism, hypovolaemia)
what investigations are carried out to determine if a patient has angina?
- ECG (resting and exercise)
- Angiography
- Echocardiography
- Isotope studies
what is an angiography?
dye is used to look at the patency of the patients arteries
what is an echocardiography?
ultrasound is used to look at the function of the heart valves & ventricles
what can be seen on the ECG of a patient suffering from angina?
- ST segment elevation
- ST segment depression
how does the ST segment alter as ischaemia increases?
ST-segment depression increases
what are the two main treatment methods for angina?
- reduce oxygen demands of the heart
- increase oxygen delivery to the tissues
how can oxygen demands of the heart be reduced?
- reduce after load/blood pressure
- reduce preload/venous filling pressure
- correct mechanical issues (failing heart valves/septal defects)
how can oxygen delivery to the tissues be increased in a patient suffering from angina?
- dilate blocked/narrowed vessels
- bypass blocked/narrowed vessels
what is the procedure called when a narrowed vessel is stretched using a balloon?
angioplasty
if oxygen to the heart is limited due to blocked vessels, what procedure may be carried out?
coronary artery bypass grafting (CABG)
what are some modifiable risk factors that can be altered to treat angina?
- stop smoking
- graded exercise programme
- improve diet/control cholesterol
what drug may be given to an angina patient in order to prevent the MI risk?
aspirin
what drugs may be used to control hypertension in patients suffering from angina?
- diuretics
- Ca channel antagonists
- ACE inhibitors
- beta blockers
what drugs may be used to reduce the heart filling pressure or dilate coronary arteries in an angina patient?
nitrates (short acting and long acting)
what immediate treatment can be provided to angina patients?
GTN spray/tab
what is the function of GTN spray/tab?
reduced preload of the heart
what problem may arise during an angioplasty & stunting procedure?
vessel rupture
what causes peripheral vascular disease?
atheroma in the femoral/popliteal vessels
what can eventually occur due to peripheral vascular disease?
necrosis/gangrene in lower legs
what is infarction of the heart caused by?
coronary artery atheroma/embolism
what is infarction of the limbs caused by?
femoral and popliteal atheroma/embolism
what is infarction of the brain? wear causes thiss?
- stroke!
- atheroma/embolism in the carotid artery
when infarction is expected in a patient, what strategies are carried out to minimise impact?
REDUCE tissue loss from necrosis - open blood flow to ischaemic tissue - bypass obstruction PREVENT further episode - aspirin
what methods may be used to open blood flow to ischaemic tissue?
- thrombolysis
- angioplasty
what are the main symptoms and signs of a myocardial infarction?
- crushing chest pain
- nausea
- pale
- sweaty
- ‘going to die’ feeling
what ECG findings may indicate that a myocardial infarction is the diagnosis?
- STEMI
- NSTEMI
what immediate care must be provided if a patient suffers a myocardial infarction in the dental surgery?
- phone ambulance
- aspirin!!!
- basic life support if required
what hospital treatments may be carried out to a patient who is suffering a myocardial infarction up to 3 hours from onset of symptoms?
acute angioplasty and stenting
how is an angioplasty carried out?
- catheter inserted through artery (femoral or radial)
- moved to site of blockage under x-ray control
- balloon inflated to open blockage
- metal stent clicks rigid to hold vessel open
what hospital treatment may be provided to a patient suffering from a myocardial infarction up to 6 hours from onset of symptoms (late presenting)?
thrombolysis
what are some contraindications of thrombolysis treatment?
- any recent blood clots are dissolved (previous surgery etc)
- sever hypertension
- diabetic eye disease, liver disease, pregnancy
what complications may a patient experience due to a MI?
- death!
- post MI arrhythmias
- heart failure
- DVT & pulmonary embolism
why may DVT & pulmonary embolism occur to MI patients?
immobility during treatment
what drugs may be used to prevent a secondary myocardial infarction?
- aspirin
- beta blocker
- ACE inhibitor
how does an NSTEMI myocardial infarction present on an ECG & what are the troponin levels?
- normal, inverted T waves or ST depression
- elevated troponins
how does a STEMI myocardial infarction present on an ECG & in terms of troponin levels?
- hyper acute T waves or ST elevation
- elevated troponin level
what is a STEMI myocardial infarction?
complete occlusion of the blood vessel lumen
