angina

Question 1

investigations for typical agina

Answer 1

ECG - to see st level
bloods (anemia can cause chest pain too)
CT coronary angigraphy
stress echo

Question 2

what 2 /3 features is associated with angina

Answer 2

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

Question 3

tx of typical angina

Answer 3

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!

Question 4

when would you suspect ACS IN TYPICAL ANGINA

Answer 4

if after 2 doses of GTN the pain hasnt subsisde

Question 5

warn patients about side effects of nitrates

Answer 5

dizziness
flushing

Question 6

second line

Answer 6

bb and longer acting DHP ca channel blocker

Question 7

indications for CABG

Answer 7

if a person has triple vessel disease
still have symptoms despite on treatment

Question 8

what makes up ACS

Answer 8

1. UNSTABLE ANGINA
2. STEMI
3. NSTEMI

Question 9

CRITERIA FOR UNSTABLE

Answer 9

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

Question 10

CRITERIA FOR NSTEMI

Answer 10

Chest pain at rest or minimal exertion lasting >15 minutes

ECG changes (new ST-depression of T wave inversion)

Rise in troponin: myocardial necrosis

Question 11

SO WHATS THE DIFFERENCE BETWEEN NSTEMI AND UNSTABLE

Answer 11

the troponin levels

Question 12

differnece between stemi and n stemi

Answer 12

nstemi - partially occluded

stemi - fully occluded

Question 13

criteria for STEMI

Answer 13

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

Question 14

when to consider a PCI

Answer 14

if patint has come hospital and within 90 mins MAX 2 HOURS send them to the closes specialist centre

Question 15

what does pci entail

Answer 15

a stent to bypass the obstruction

Question 16

what if patient is not eligible for PCI

Answer 16

fibrolytic therapy - MUST CHECK FOR CI

Question 17

CI FOR FIBRINOLYTIC

Answer 17

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

Question 18

TX OF NSTEMI

Answer 18

you calculate whether high risk(revasularization) or low risk (usually more conservative)

Question 19

levels of troponin after MI

Answer 19

roponin levels peak about 24 hours after the infarction, and then gradually lower back to baseline over the next 1-2 weeks

Question 20

CAUSES OF RAISED TROPONIN

Answer 20

Arrhythmias
Coronary artery spasms
Aortic dissection
Severe hypertension
Chronic kidney disease
Pulmonary embolism
Sepsis

Question 21

4 changes in a NSTEMI ECG

Answer 21

T wave inversion, ST depression, flat T waves/pseudo-normalisation of previously inverted T waves; normal ECG

Question 22

What must be considered in terms of the time when a troponin sample is taken?

Answer 22

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

Question 23

DEFIINTVE TX OF STEM

Answer 23

ercutaneous Coronary Intervention (PCI)

Question 24

What do Q-waves represent in the context of myocardial infarction?

Answer 24

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

Question 25

WE ALWAYS ADMINISTER MORPHINE WITH

Answer 25

ANTIEMETICS AND PERHAPS LAXITIVE

Question 26

What early signs of STEMI may be seen on an ECG?

Answer 26

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.

Question 27

treatment of unstable angina

Answer 27

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