Angina + ACS Flashcards
Compare Typical and Atypical chest pain
Typical: Pain at rest/ exertion in Arms/ Jaw/ Neck/ Stomach
Atypical: Pain on bending/ eating, SoB on exertion
List investigations in Angina pts
- ECG (Normal doesn’t rule out SA)
- FBC, Glucose, Cholesterol, U&Es
- Thyroid hormones
How is Unstable Angina treated?
Admission to Hospital or Rapid Access Chest Pain Clinic
In addition to referral to Rapid Access Chest Pain Clinic, How is Stable Angina treated pharmacologically?
(1st, 2nd, 3rd, 4th lines)
GTN for rapid relief/ immediate prevention (if no relief, call ambulance)
1: B-blocker or CCB
2: Nicorandil, Ranolazine, Ivabradine or Long-acting Nitrate (Isosorbide nitrate)
3: Poor control on maximum licensed/ tolerated dose, switch to/add a different drug class
4: Poor control on max. licensed/ tolerated doses of 2 drugs, refer to cardiologist
List 2ndary prevention treatments in Angina pts
- All with SA: Antiplatelets (Low dose Aspirin, 75mg)
ACEi;
- If Systolic>140 or Diastolic> 90
- Confirmed CVD/ CKD
- Consider if SA and DM
- High dose Statin
Outline the follow-up in Angina pts being treated
Review 2-4wks after starting/ changing treatment
What are 3 Acute Coronary Syndromes?
List 2 investigations
- Unstable Angina, STEMI, NSTEMI
- ECG, Troponin
Outline general treatment for ACS
Revascularisation procedures (PCI, CABG) + drugs;
- Aspirin loading dose
- GTN for relief (IV opioids may be used)
Outline STEMI treatment
- Fibrinolysis/ PCI (if within 12hrs of symptom onset/ 120mins of time Flysis could’ve been given)
- Aspirin + another antiplatelet agent (Prasugrel, Clopidogrel, Ticagrelor)
- Add UF Heparin if PCI with Radial Access
Outline treatment of NSTEMI and UA
Same
- Aspirin + another antiplatelet agent.
- Also offer Fondaparinux unless immediate Coronary Angiography or high bleed risk.
- Unfractionated Heparin if significant renal impairment.
