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Case 1 Chest Pain > Angina + ACS > Flashcards

Angina + ACS Flashcards

1
Q

What are the causes of myocardial ischaemia?

A

Coronary artery disease, aortic stenosis, Hypertrophic cardiomyopathy, tachyarrythmia, cocaine use, anaemia, thyrotoxicosis

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2
Q

What is angina?

A

symptom complex caused by transient myocardial ischaemia

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3
Q

What are the 3 characteristics of typical angina?

A
  • constricting discomfort in the front of the chest, or in the neck, shoulders, jaw or arms
  • precipitated by physical exertion
  • relieved by rest or GTN within about 5 minutes.
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4
Q

What are precipitants of angina?

A

Cold weather, heavy metals and emotion

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5
Q

What are the associated symptoms of angina?

A

dyspnoea, nausea, sweatiness, faintness

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6
Q

What is stable angina?

A

Induced by effort, relieved by rest.

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7
Q

What is unstable angina?

A

angina of increasing frequency and severity, occurs on minimal exertion or at rest

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8
Q

What is decubitus angina?

A

angina precipitated by lying flat

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9
Q

What is causes prinzmetal angina?

A

coronary artery spasm

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10
Q

How is stable angina initially managed?

A

Blood - identify condition which exacerbates angina

Aspirin

ECG

GTN spray

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11
Q

What is first line diagnostic investigation for angina?

A

CT coronary angiography

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12
Q

What is exercise testing used for?

A

assessing the severity of coronary disease and identifying high-risk individuals

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13
Q

What is used in secondary prevention of CVD?

A

Stop smoking, exercise, dietary advice, optimise HTN, diabetes control

75mg OD Aspirin

Address hyperlipidaemia with Statins

ACE-I if diabetic

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14
Q

What are first line anti-anginal drug treatments?

A

Beta-blockers (atenolol/bisoprolol) or Calcium channel antagonists (amlodipine/diltiazem/verapamil)

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15
Q

What is second line treatment for angina?

A

Long acting Nitrate (Isosorbide mononitrate)

OR

Nicorandil

OR

Ivabradine

OR

Ranolazine

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16
Q

Why are ACE-I used for diabetics with stable angina?

A

ACE inhibitors represent a vasculoprotective and renoprotective effect for people with diabetes.

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17
Q

What is the MoA of nicorandil?

A

K+ channel activators

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18
Q

What is MoA of ivabradine?

A

If (funny) Channel Antagonist

19
Q

What is initial treatment for suspected ACS?

A

300mg Aspirin loading dose

20
Q

What is ACS?

A

a term that encompasses both unstable angina and myocardial infarction (MI)

21
Q

What is MI?

A

symptoms occur at rest and there is evidence of myocardial necrosis, as demonstrated by an elevation in cardiac troponin or creatinine kinase-MB isoenzyme

22
Q

What are the symptoms of ACS?

A

Chest pain - tightness/heaviness that radiates to jaw or arm, breathlessness, N and V, collapse

23
Q

How does sudden death occur in MI?

A

from ventricular fibrillation or asystole

24
Q

What are the signs of ACS?

A

distress, anxiety, pallor, sweatiness, altered pulse rate, signs of heart failure, pan-systolic murmur

25
Q

What investigations are carried out in suspected ACS?

A

ECG, Cardiac troponin levels, echocardiogram, coronary angiography

26
Q

What type of MI occurs when ST-segement elevation arises?

A

transmural (full-thickness) infarction due to proximal occlusion of a coronary artery

27
Q

What type of infarction is non ST-elevation MI?

A

partial-thickness (subendocardial) MI due to is partial occlusion of a major vessel or complete occlusion of a minor vessel

28
Q

How is MI diagnosed?

A

History, ECG and troponin measurements

29
Q

What is the GRACE score?

A

Ischaemic risk score

30
Q

What is the CRUSADE score?

A

Bleeding risk score

31
Q

How is ACS immediately managed? (6)

A 
Morphine + metclopramide
Oxygen
Nitrates (GTN Sublingual)
Aspirin 300mg
Clopidogrel 300mg/Ticagrelor 180mg
IV beta-blockers
32
Q

Who is offered PCI?

A

for people with acute STEMI if:

  • presentation is within 12 hours of onset of symptoms and
  • primary PCI can be delivered within 120 minutes of the time when fibrinolysis could have been given.
33
Q

When should thrombolysis be used?

A

people with acute STEMI presenting within 12 hours of onset of symptoms if primary PCI cannot be delivered within 120 minutes of the time when fibrinolysis could have been give

34
Q

What drug is used to thrombolyse?

A

Alteplase

35
Q

What should offered after thrombolysis?

A

ECG 60-90 mins after

36
Q

How is NSTEMI managed?

A

beta-blocker, anti-thrombotic (LWMH/fondaparinux), assess risk with GRACE score

37
Q

How are high risk NSTEMI patients managed?

A

GPiib/iiia antagonist (eg tirofiban, abcixmab), or bivalirudin

Angiography within 96hours

Clopidogrel + Aspirin

38
Q

What is use in long-term managed for ACS (10)?

A 
Aspirin 75mg OD lifelong
Clopi + Aspirin for 12 months
PPI - gasto-protection
Anti-coagulate - until discharge
Statins
Beta-blocker if LV impairment
ACE-I/ARB
Aldosterone antagonists – patients taking beta blockers and ACE inhibitors with LVEF <35%
Enrolment in secondary prevention programme
Modify risk factors
39
Q

What medication can be offered to those who are to undergo PCI? (5)

A

ticagrelor or prasugrel or cangrelor + heparin or bilvalirudin

40
Q

A 45-year-old gentleman presents to the emergency department with nausea, sweating and severe central crushing chest pain which radiates to his left arm. His ECG shows widespread ST depression with T wave inversion. His blood tests identify a haemoglobin level of 75g/L. What is used to treat his anaemia?

A

transfusion of packed red cells

41
Q

What are the ECG criteria to diagnose STEMI?

A

New LBBB or >/= 1mm ST elevation in II and III

42
Q

What does the cardiac rehabilitation programmed involve?

A

Stress management

taking into account physical demands of work when advising return

43
Q

What are possible causes of myocardial ischaemia in younger patients?

A

Aortic Stenosis, cocaine use, HOCM, anaemia

Case 1 Chest Pain (2 decks)

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