angina Flashcards
investigations for typical agina
ECG - to see st level
bloods (anemia can cause chest pain too)
CT coronary angigraphy
stress echo
what 2 /3 features is associated with angina
Constriction like pain in chest/neck/arm/jaw
Brought on by physical activity
Alleviated by rest or glyceryl trinitrate within minutes
2/3 features indicate atypical angina pain
tx of typical angina
aspirin
GTN- tell patient to take another does if it doesn’t leave after 5 mins
you always give GTN with either a bb or calcium channel blocker because some patients cant tolerate a bb!
when would you suspect ACS IN TYPICAL ANGINA
if after 2 doses of GTN the pain hasnt subsisde
warn patients about side effects of nitrates
dizziness
flushing
second line
bb and longer acting DHP ca channel blocker
indications for CABG
if a person has triple vessel disease
still have symptoms despite on treatment
what makes up ACS
- UNSTABLE ANGINA
- STEMI
- NSTEMI
CRITERIA FOR UNSTABLE
Chest pain at rest or minimal exertion lasting >15 minutes
ECG changes (new ST-depression or T wave inversion)
NO rise in troponin: no myocardial necrosis
CRITERIA FOR NSTEMI
Chest pain at rest or minimal exertion lasting >15 minutes
ECG changes (new ST-depression of T wave inversion)
Rise in troponin: myocardial necrosis
SO WHATS THE DIFFERENCE BETWEEN NSTEMI AND UNSTABLE
the troponin levels
differnece between stemi and n stemi
nstemi - partially occluded
stemi - fully occluded
criteria for STEMI
STEMI = completely occluded coronary artery
Chest pain at rest or minimal exertion, lasting >15 minutes
ECG changes (new ST-elevation or left bundle branch block)
RISE IN TROPONIN
when to consider a PCI
if patint has come hospital and within 90 mins MAX 2 HOURS send them to the closes specialist centre
what does pci entail
a stent to bypass the obstruction
what if patient is not eligible for PCI
fibrolytic therapy - MUST CHECK FOR CI
CI FOR FIBRINOLYTIC
AGAINST
Aortic Dissection
GI bleed
Allergic reaction
Iatrogenic: recent surgery
Neurological disease: recent stroke (within 3 months), malignancy
Severe HTN (>200/120)
Trauma, including recent CPR
TX OF NSTEMI
you calculate whether high risk(revasularization) or low risk (usually more conservative)
levels of troponin after MI
roponin levels peak about 24 hours after the infarction, and then gradually lower back to baseline over the next 1-2 weeks
CAUSES OF RAISED TROPONIN
Arrhythmias
Coronary artery spasms
Aortic dissection
Severe hypertension
Chronic kidney disease
Pulmonary embolism
Sepsis
4 changes in a NSTEMI ECG
T wave inversion, ST depression, flat T waves/pseudo-normalisation of previously inverted T waves; normal ECG
What must be considered in terms of the time when a troponin sample is taken?
Troponin will not start to rise until 2 - 3 hours after the onset of ischaemia
Troponin levels generally peak at around 24 hours after myocardial injury
Troponin elevation may persist for 1 - 2 weeks following myocardial injury
DEFIINTVE TX OF STEM
ercutaneous Coronary Intervention (PCI)
What do Q-waves represent in the context of myocardial infarction?
hat do Q-waves represent in the context of myocardial infarction?
Full-thickness myocardial infarction, they develop once myocardial injury is complete and generally no longer reversible
WE ALWAYS ADMINISTER MORPHINE WITH
ANTIEMETICS AND PERHAPS LAXITIVE
What early signs of STEMI may be seen on an ECG?
In STEMI this is characterised by a ST-elevation on the ECG. There may be peaked T waves which are suggestive of a hyperacute STEMI.
treatment of unstable angina
well because now a clot is actually there, this is a risk for furture MI, so we take aspirin as well as bacially other antihypertensive drugs too like ca2+ , nitrates etc
