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Cardiovascular > Angina, ACS + MI > Flashcards

Angina, ACS + MI Flashcards

1
Q

Causes of angina

A

CHD most commonly

HOCM, valve disease, arrhythmias, anaemia, thyrotoxicosis

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2
Q

S+S angina

A

Pain - episodic, central crushing/ band like, radiating to jaw/ neck/ arms
Precipitated by exertion, cold, emotion + heavy meals
Relieved by rest + GTN spray
Associated with palpitations, sweating, nausea, SOB

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3
Q

RF for angina

A

Smoking, fam hx, hx of CVA/ TIA/ VTE

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4
Q

Investigations for angina

A

Bloods

12 lead resting ECG

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5
Q

Non-pharmacological treatment of angina

A 
Smoking cessation 
Treat HTN 
Diet - oily fish, low cholesterol 
Reduce alcohol 
Increase exercise
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6
Q

Driving + angina

A

Group 1 - stop until symptoms controlled if attack was during rest, at wheel or with emotion
Group 2 - inform DVLA + revoked license until symptom free for >6 weeks

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7
Q

PRN treatment + SE for angina

A

GTN 1-2 puffs as needed

SE: flushing, headaches, light headedness

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8
Q

Regular treatment for angina

A

B blocker or Ca channel blocker
2nd line: combine
3rd line: long acting nitrates, nicorandil, ivabradine

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9
Q

What is secondary prevention of angina?

A

Aspirin 75mg OD or clopidogrel if aspirin intolerant
Statins to decrease total cholesterol
ACEi decrease deaths

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10
Q

When should angina be referred to cardiology?

A 
Unstable/ rapidly progressing
aortic stenosis + angina 
Angina following MI
Abnormal ECG 
Angina not controlled by 2 drugs 
Strong family hx
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11
Q

What is unstable angina?

A

Pain with no exertion/ at rest

Angina that is rapidly worsening in intensity, frequency or duration

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12
Q

When to use surgery for angina + what options are there?

A

If symptoms not controlled with 2 drugs
Coronary revascularisation with bypass surgery (CABG) or percutaenous intervention (PCI)

CABG better in DM, >65 y/o, left anterior descending artery disease

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13
Q

What is prinzmetal/ variant angina?

A

Angina at rest resulting from coronary artery sparm
ECG shows ST elevation
Ca channel blockers to prevent
GTN spray PRN

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14
Q

What is cardiac syndrome X?

A

Ongoing angina symptoms despite normal coronary angiography

Treat with B blockers/ Ca channel blockers

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15
Q

Driving post MI

A

Group 1: stop driving for 1 week if successfully treated with angioplasty, otherwise for 1 month
Group 2: license revoked, review after 6 weeks

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16
Q

Sexual activity post MI

A

No increased risk - safe to do so around 4-6 weeks after

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17
Q

Return to work guide post MI

A

Sedentary jobs = 4-6 weeks
Light manual = 6-8 weeks
Heavy manual = 3 months

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18
Q

Drug treatment post MI

A

ACEi
Aspirin
Clopidogrel/ ticagrelor for up to 12 months in NSTEMI, 4 weeks in STEMI
B blocker for 12 months (diltiazem/ verapamil if CI)
Statins
Spironolactone if signs of HF

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19
Q

Antiplatelet therapy post MI

A

Aspirin indefinitely
Ticagrelor/ clopidogrel for 12 months in NSTEMI or PCI/ stent
4 weeks only in STEMI

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20
Q

What is dressler syndrome?

A

Develops 2-10 weeks post MI - due to autoantibodies to heart muscle
Recurrent fever + chest pain+ pleural/ pericardial effusion

Treat with steroids + NSAIDs

21
Q

Statin therapy cautions

A

Inhibit liver enzymes P450
LFTs need checking within 3 months of starting statins + after 12 months
Take at night due to cholesterol being made at night

22
Q

SE of statins

A

Rhabdomyolysis + muscle breakdown - muscle aches + pains

23
Q

B blockers therapy monitoring

A

Check HR - caution with bradycardia

Check BP

24
Q

ACEi therapy monitoring

A

U+Es - can cause postural hypotension + hyperkalaemia

Can cause AKI (also with NSAIDs)

25
Q

?ACS investigations

A

ECG and troponin

TFTs, cholesterol, BM (can get raised even non-diabetics), FBCs, U+Es

26
Q

ACS troponin results

A

Raised after 4-8hrs, peak 18-24, elevated for 10 days

27
Q

STEMI investigations results + characteristic presentation

A

Raised troponin, ECG ischaemia (ST elevated, new LBB, T wave inversion)
Chest pain not relieved by GTNN+V, clammy, chest pain
Elderly + diabetics can get painless STEMIs - presenting as delirium

28
Q

NSTEMI investigations results + characteristic S+S

A

Chest pain, raised troponin, ECG can show ischaemia (ST depression, T wave inversion)

29
Q

Angina investigations results + characteristic S+S

A

Chest pain, no raised troponin, no ECG ischaemia

30
Q

ACS acute management

A 
MONATH
Morphine 10mg IV
O2 (if critically unwell)
GTN spray
Aspirin 300mg stat
Ticagrelor 180mg
Heparin (if angiography likely in 24hrs) or fondaparinux (if PCI unlikely)
BB or diltiazem if they are contraindicated
31
Q

STEMI acute management

A

MONATH (remember - heparin if PCI is likely)
Coronary angiography + PCI if it can be done within 120 mins, fibrinolysis if not
Fibrinolysis with alteplase

32
Q

NSTEMI acute management + criteria used to assess

A

BEMOAN / MONATH + BB
BB
Enoxaparin
Morphine
O2
Aspirin
Nitrates
GRACE criteria (risk of death or MI in hospital in 6 mths)
Low risk = fondaparinux + ticagrelor (continue for 12 months)
High risk (>3%) = Intravenous glycoprotein IIb/IIIa receptor antagonists (eptifibatide or tirofiban) + PCI within 96 hours
TIMI risk score >3 = LMWH + angiography

33
Q

PCI eligibility

A

Need Chest pain and ECG changes or chest pain within 12hrs and ECG change
On ECG need ST elev over 2 in chest lead, 1 in limb, or new LBBB

34
Q

Minimum long term therapy after ACS

A 
Aspirin
Clopidogrel
Beta blocker
Ace inhibitor
Statin
35
Q

Flow chart for cardiac arrest

A

Unconscious - call resus team - head tilt chin lift - CPR 30:2 - attach defib - assess rhythm
Adrenaline every 5 mins (1mg IV) + amiodarone after 3 shocks

36
Q

What is a type I MI?

A

Caused by plaque rupture

37
Q

What is a type II MI?

A 
MI secondary to ischaemia due to increased O2 demand or decreased supply, due to:
Coronary artery spasm
Coronary embolism
Anaemia
Arrhythmias
HTN
Hypotension
38
Q

Reversible causes of cardiac arrest

A 
Hypoxia 
Hypovolaemia 
Hypothermia 
Hypo/hyperkalaemia 
H+ (acidosis)

Tension pneumothorax
Tamponade
Toxins
Thrombosis

39
Q

When to offer coronary angiography + PCI for an acute STEMI?

A

If symptoms within 12 hours of onset + if primary PCI can be delivered within 120 mins of time when fibrinolysis could have been given

40
Q

What is the criteria for a STEMI?

A

1mm STEMI in inferior lead
2mm STEMI in anterior lead
New onset LBBB

41
Q

What does a posterior MI look like on ECG?

A

V1 - V3 ST depression

42
Q

What do leads V1 + V2 show?

A

Right ventricle

43
Q

Which ECG lead shows right atrium?

A

AVR

44
Q

When + where is T wave inversion normal?

A

Normal in V1+V2 (normal in females) + v1,2,3 in Afro-caribbeans

45
Q

Complications of MI

A 
CRASH PAD 
Cardiac Rupture 
Arrhythmia
Shock 
HTN/ HF 
Pericarditis/ PE
Aneurysm 
DVT
46
Q

What is PCI?

A

Percutaneous coronary intervention

Balloon angioplasty or stenting

47
Q

What is CABG?

A

Coronary artery bypass graft surgery

For stenosed CA

48
Q

When would you do CABG over PCI?

A

Triple vessel or left main disease

DM

49
Q

S+S of MI in elderly women

A

Dizziness, back pain, light-headedness, weakness

Cardiovascular (15 decks)

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