Angina Flashcards

Question

Mechanism of BB in angina | + SEs

Answer 1

Decrease HR, LV wall tension, and contractility. SE: fatigue, cold peripheries, diarrhoea, nausea

Answer 2

Decreases LV wall tension and contractility, increases coronary flow SE: flushed face, headaches, dizziness, tiredness, skin rashes, peripheral oedema

Answer 3

SE: headache, flushed face, hypotension. | Mechanism = vasodilation.

Answer 4

*Patient has to be in sinus rhythm. SE: temporary flashes of brightness in field of vision, bradycardia, AF. Mechanism – If channel blocker, reduces pacemaker activity so reduces HR.

Answer 5

Inhibits Na+ current, decreases ventricular diastolic tension SE: constipation, dizziness, feeling weak, prolongs QTc.

Answer 6

Potassium channel activator, increases coronary flow, decreases LV wall tension Contraindicated in acute pulmonary oedema, severe hypotension, hypovolaemia, LV failure. SE: dizziness, headaches, nausea and skin, mucosal, eye and GI ulceration.

Answer 7

* New onset angina * Exclusion of angina in high risk individuals with atypical symptoms * Worsening angina in patient with previously stable symptoms * New or recurrent angina in patient with history of MI or coronary revascularisation * Assessment of occupational fitness (e.g. airline pilots)

Answer 8

New onset angina or abrupt deterioration in previously stable angina, often occurring at rest Requires immediate admission or referral to hospital Part of acute coronary syndrome

Answer 9

Thrombus breaks down before infarction occurs (<20 minutes) so there are no raised cardiac markers

Answer 10

Retrosternal chest pain radiating to jaw, arm or neck. Sweating, nausea, breathlessness, and tachycardia. Prolonged (>15 minutes) May be new or deterioration of stable angina (e.g. more frequent, at rest) Haemodynamic instability

Answer 11

ECG High-sensitivity troponin I or T measurement (not elevated in angina) Glucose, lipids, U+E (for CVD risks) FBC (anaemia can exacerbate angina) Thyroid function tests LFTs and amylase — for differentials (cholecystitis and pancreatitis) CRP and ESR — for infection or inflammation. CXR — rule out heart failure and pulmonary pathology (not routine) May do other investigations if ECG inconclusive e.g. echo, myocardial perfusion study, coronary angiography

Answer 12

Pathological Q waves Left bundle branch block ST-segment and T-wave abnormalities (for example T-wave flattening or elevation, or T-wave inversion)

Answer 13

Morphine 2-5mg IV every 5-30 minutes when required (+ metoclopramide) Oxygen (if needed) Nitrates - GTN 0.3-0.6mg sublingually every 5 minutes or 1-2 sprays every 2-5 minutes (max 3 in 15 mins) Aspirin - 300mg Beta blockers (or diltiazem/verapamil) Clopidogrel - 300mg Heparin (unfractionated), LMWH, or fondaparinux - if angiography planned within 24 hours Beta blockers (or diltiazem/verapamil) Glycoprotein IIb/IIIa inhibitors e.g. eptifibatide, tirofiban, abciximab Revascularisation procedures or conservative management if mortality 3% or less

Answer 14

If 6 month mortality above 3% or scheduled to undergo angiography within 96 hours or as adjunct to PCI

Answer 15

if undergoing PCI within 24 hours or 6 month mortality of more than 1.5%

Answer 16

AS ABC: ACE inhibitor Statin aspirin beta-blocker clopidogrel

Answer 17

* Haemodynamic instability * Pain refractory to medical treatment * Life-threatening arrhythmias or cardiac arrest * Mechanical complications of MI * Acute heart failure with refractory angina or ST deviation * Recurrent dynamic ST or T wave changes, particularly with intermittent ST elevation

Answer 18

Rise or fall in troponin Dynamic ST or T wave changes GRACE score >140

Answer 19

Predicted 6 month mortality above 3%

Answer 20

Activates antithrombin III Side effects - bleeding thrombocytopenia, osteoporosis, hyperkalaemia

Answer 21

Block β1 receptors in the heart Decrease HR, contractility, and AVN conductivity ``` Side-effects bronchospasm cold peripheries fatigue sleep disturbances, including nightmares erectile dysfunction ```

Answer 22

antagonist of the P2Y12 (ADP) receptor, inhibiting the activation of platelets

Answer 23

Blocks COX1 AND 2 (reduces ability of platelets to aggregate) S/Es - dyspepsia; haemorrhage CAN GET BRONCHOSPASM, ASTHMA ATTACK

Answer 24

Systemic + coronary vasodilation | SE: headaches, low BP

Answer 25

Arrhythmias; confusion; constipation; dizziness; drowsiness; dry mouth; euphoric mood; flushing; hallucination; headache; hyperhidrosis; hypotension (with high doses); miosis; nausea (more common on initiation); palpitations; respiratory depression (with high doses); skin reactions; urinary retention; visual impairment; vomiting (more common on initiation); withdrawal syndrome

Answer 26

Inhibits activated factor X | Common S/Es = anaemia; haemorrhage

Answer 27

Inhibit conversion of angiotensin 1 to 2 and so reduce sympathetic activity + vasoconstriction Common S/E = dry cough, dizziness, headaches, diarrhoea, vomiting, skin rash, blurred vision, renal impairment Serious S/Es = hepatitis, pancreatitis, agranulocytosis and other blood disorders, MI

Answer 28

Inhibit HMG-CoA reductase S/Es = myopathy, liver impairment, increased risk o f intracerebral haemorrhage in those who have had a stroke

Answer 29

``` Severe stenosis (>70%) with left main stem or triple vessel disease >50% stenosis + unresponsive severe angina, marked ST depression on exercise ECG, LMS stenosis, severe 3VD, or angina with LV dysfunction. ```

Angina Flashcards

(53 cards)