Acute coronary syndromes & pharmacotherapeutics Flashcards
What is ACS?
This is an umbrella term for medical emergencies associated with acute chest pain related to unpredictable, sudden onset myocardial ischemia
Can unstable angina be relieved by GTN?
it is not (or at best only partially) relieved by GTN
describe interesting things about STEMI
ST-segment elevation MI
ECG exhibits ST segment elevation (& later on, abnormal Q wave)
Associated with elevated biomarkers of cardiac muscle damage (necrosis) ie cardiac troponins (I/T), indicating infarction
May also be elevations in cardiac enzymes: creatine kinase MB, aspartate transaminase, lactate dehydrogenase
Associated with prolonged, full occlusion of coronary artery
Linked with transmural infarct development (ie affects full myocardial thickness)
Reperfusion is a very urgent treatment priority eg with use of fibrinolytics and/or primary percutaneous coronary intervention (PCI)
LIST THE 5 DRUG CLASSES WITH THEIR EXAMPLES USED IN MEDICINES USED IN ACS MANAGEMENT
Fibrinolytics (for STEMI)
eg alteplase, reteplase, tenecteplase, streptokinase
Antiplatelet agents
eg aspirin, clopidogrel, prasugrel, ticagrelor, abciximab, eptifibatide, tirofiban
Anticoagulants
eg heparin, enoxaparin, fondaparinux, bivalirudin
Analgesics
eg morphine with Antiemetics
eg metoclopramide
Antiischaemic agents
organic nitrates like GTN
β-blockers/non-dihydropyridine calcium channel blockers as alternative
eg bisoprolol, metoprolol / verapamil, diltiazem
LIST THE 4 DRUG CLASSES WITH THEIR EXAMPLES USED IN SECONDARY PREVENTION POST-MI
Antiplatelet agents
eg aspirin, clopidogrel, ticagrelor
Antiischaemic agents
*β-blockers/non-DHP calcium entry blockers as alternative
eg bisoprolol, metoprolol / verapamil, diltiazem
Lipid-lowering agents
statins
eg atorvastatin
RAAS inhibitors
eg ACE inhibitors/ARBs as alternative
eg ramipril / candesartan
NB: antidepressants may also be indicated eg citalopram, sertraline to aid rehabilitation
What is “crescendo angina”?
an increase in frequency and exacerbation of ischemic pain over time
Does unstable angina cause myocardial infarction?
cardiac troponins (represented by troponins I and T) are not raised in UA, indicating no myocardial infarction.
What is ischemia?
Ischemia is related to atherosclerotic plaque rupture and thrombosis, leading to either the partial or full occlusion of coronary vessels and may lead to cardiac cell death
What is the outcome of ACS?
The diagnostic outcome is either unstable angina (UA) or myocardial infarction (MI) (NSTEMI and STEMI variants, depending on ECG) with attendant necrosis
Complications of ACS include?
Complications of ACS include
heart failure
arrhythmia
sudden cardiac death
thromboembolic events.
Myocardial ischemia (lack of blood flow) and associated hypoxia results from a fundamental inequality: ________
Cardiac blood/oxygen supply ≠ demand
Myocardial ischaemia can develop over time into _______ (myocardial infarction (MI)), indicated by the release of cardiac proteins (troponins) and also enzymes from damaged cardiac muscle
Myocardial necrosis
What are the symptoms of Myocardial?
Symptomology include: crushing chest pain that can radiate to eg left arm, neck and jaw; shortness of breath (dyspnea); nausea or vomiting; dizziness; cold, pale skin; sweatiness (diaphoresis); and severe anxiety
Does Non-ST-segment elevation MI
based on the ECG record ST segment elevation?
may record either no change or ST segment depression but not ST segment elevation.
Does Non-ST-segment elevation MI cause myocardial necrosis?
cardiac troponins (represented by troponins I and T) are raised in NSTEMI, confirming myocardial necrosis.
