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Cardiology > Angina + ACS > Flashcards

Angina + ACS Flashcards

1
Q

Why are the 3 main ‘typical’ features of angina chest pain?

A
  • constricting discomfort in front of chest, neck, shoulders, jaw or arms
  • precipitated by exertion
  • relieved by rest or GTN within about 5 minutes
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2
Q

What is the difference between stable and unstable angina?

A

Stable angina is induced by effort and relieved by rest

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

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3
Q

Which investigations should be done for suspected angina?

A 
12 lead ECG
Bloods to exclude precipitating factors
Exercise tolerance test (ECG)
CT coronary angiogram
Non-invasive functional imaging e.g. myocardial perfusion scan?
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4
Q

What might been seen on an ECG in suspected angina?

A

Usually normal
May be signs of previous MI
- ST depression
- flat/inverted T waves

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5
Q

Which angina precipitating factors are you looking for in blood tests?

A 
Anaemia
Diabetes
Hyperlipidaemia
Thyrotoxicosis
Temporal arteritis
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6
Q

Which investigation is best for assessing risk in suspected angina?

A

Exercise tolerance test

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7
Q

Which investigation is best for guiding management of angina?

A

CT coronary angiogram

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8
Q

When should revascularisation be considered for angina?

A

Severe symptoms
High risk
Symptoms not controlled by medications

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9
Q

What are the main steps in management of angina?

A
  • lifestyle advice
  • GTN
  • beta blocker e.g. atenolol
  • CCB e.g. amlodipine, nifedipine
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10
Q

What are the side effects of GTN?

A

Flushing
Headache
Light headedness

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11
Q

What advice should be given to a patient about use of GTN?

A
  • use immediately before exercise or at onset of pain
  • repeat dose after 5 minutes if pain not gone
  • call ambulance if pain not gone 5 mins after taking second dose
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12
Q

What are some contraindications to beta blockers?

A 
Asthma
COPD
LVF
Bradycardia
Coronary artery spasm
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13
Q

What is the next step in management of angina if symptoms not controlled with beta-blocker + CCB?

A

Consider mono therapy with:

  • ISMN
  • Ivabradine
  • Nicorandil
  • Ranolazine
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14
Q

What should be given for secondary prevention of CVD after diagnosis of angina?

A 
Aspirin 75mg daily
Atorvastatin 80mg daily
BP control
ACE inhibitor if angina + diabetes
Consider rivaroxaban in addition to aspirin if high risk of ischaemic event
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15
Q

What are the typical features of an MI?

A 
Severe crushing central chest pain
Radiating to jaw/arms etc
Longer and more severe than angina pain
Not relieved by GTN
Associated sweating, nausea and vomiting
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16
Q

What are the possible ECG changes seen in a STEMI?

A
  • ST elevation (first few hours)
  • T wave inversion
  • Q waves
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17
Q

What are the 3 criteria for diagnosis of a STEMI on an ECG?

A
  • 1mm or more ST elevation in 2 adjacent limb leads
  • 2mm or more ST elevation in at least 2 contiguous precordial leads
  • new onset bundle branch block
18
Q

Which leads would likely be affected in an inferior MI?

A

II, III and AVF

19
Q

Which leads would likely be affected in an anterior MI?

A

V1 - V6

20
Q

Which leads would likely be affected in a lateral MI?

A

I and AVL

21
Q

Which artery is likely occluded in an inferior MI?

A

Right coronary artery

22
Q

Which artery is likely occluded in an anterior MI?

A

Left anterior descending

23
Q

Which artery is likely occluded in a lateral MI?

A

Circumflex

24
Q

What pattern does serum troponin follow after myocardial ischaemia?

A

Increase within 3-12 hours from onset of chest pain
Peak at 24-48 hours
Return to baseline over 5-14 days

25
Q

When should troponin be checked?

A

Immediately on arrival in A&E
3 hours later
12 hours after symptoms onset to establish diagnosis

26
Q

What is the diagnostic criteria for an MI?

A

Rise in troponin + at least one of:

  • symptoms of ischaemia
  • new ST/T wave changes or new LBBB
  • pathological Q waves
  • new loss of viable myocardium or new regional wall motion abnormality on imaging
  • identification of intracoronary thrombus on angiography
27
Q

What is the acute management of suspected ACS?

A
  • ABCDE
  • ECG
  • Troponin level
  • Morphine/diamorphine IV + antiemetic
  • Oxygen if hypoxic
  • GTN (if BP > 90)
  • Aspirin 300mg
  • Ticagrelor 180mg PO
28
Q

Which intervention is first line for treatment of STEMI?

A

PCI

29
Q

What is the time cut off for PCI?

A

Within 2 hours of diagnosis

30
Q

What should be done if PCI is not rapidly available for STEMI?

A

Thrombolysis IV

+ fondaparinux

31
Q

How should an NSTEMI be managed?

A
  • fondaparinux or LMWH
  • IV nitrates
  • calculate GRACE score
  • -> coronary angiography if med/high risk
32
Q

Which medications should a patient be on post MI?

A

Dual anti platelet - aspirin and ticagrelor
Statin
Beta blocker
ACE inhibitor/ARB

33
Q

How long should a patient be on dual anti platelet therapy post MI?

A

Aspirin –> indefinitely

Additional anti platelet e.g. ticagrelor –> at least 12 months

34
Q

Which drug should you consider adding post MI if the patient has evidence of HF?

A

Spironolactone

35
Q

What needs to be monitored before and during treatment with spironolactone?

A

Renal function

K+

36
Q

What is Dressler’s syndrome?

A

Pericarditis, pleural effusions, fever, anaemia + increased ESR
1 - 3 weeks post MI

37
Q

In cardiac arrest, which rhythms are shockable?

A

VF

Pulseless VT

38
Q

Which rhythms are non-shockable?

A

Asystole

Pulseless electrical activity (PEA)

39
Q

During ALS, when should adrenaline be given?

A

If shockable rhythm:

  • After 3rd shock
  • Then after alternative shocks (every 3-5 mins)

If unshockable:
- asap

40
Q

Which drug, apart from adrenaline, can be given in ALS and when?

A

Amiodarone 300mg

After 3rd shock

41
Q

Name the reversible causes of cardiac arrest

A

Hypoxia
Hypovolaemia
Hypo/hyperkalaemia
Hypothermia

Thrombosis - coronary or pulmonary
Tension pneumothorax
Tamponade
Toxins

42
Q

How much adrenaline is given in ALS?

A

1mg IV

Cardiology (14 decks)

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