Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Finals - CardioResp > Angina/Acute Coronary Syndrome > Flashcards

Angina/Acute Coronary Syndrome Flashcards

1
Q

What comprises IHD?

A
  1. ACS (unstable angina, NSTEMI and ST)
  2. Stable angina
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

When does maximum coronary blood flow occur?

A

Diastole

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Which area of the heart is most vulnerable to ischemia?

A

Subendocardial area

Myocardial wall pressure is greatest in this area which is closest to LV cavity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

In which direction is the hear perfused?

A

Epicardial to Endocardial

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

In which direction is the heart depolarised?

A

Endocardium to Epicardium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

List the 4 types of MI

A
  • Type 1: Traditional MI due to acute coronary event
  • Type 2: Ischaemia 2o to increased demand or reduced supply of oxygen (eg. 2o to severe anaemia, tachycardia or hypotension)
  • Type 3: Sudden cardiac death or cardiac arrest suggestive of an ischaemic event
  • Type 4: MI associated with PCI / coronary stunting / CABG
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

List 2 non-modifiable risk factors for IHD

A
  1. Increasing age
  2. Male; females catch up after menopause
  3. FxH of premature (<60 years) CAD
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

List 2 modifiable risk factors for IHD

A
  1. Smoking
  2. Hyperlipidaemia
  3. Diabetes - doubles risk
  4. Hypertension
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is Angina?

A

Narrowing of coronary arteries reduces blood flow to the myocardium during times of high demand (ie. exercise)

Results in insufficient supply to meet demand

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

How does Angina present?

A

Constricting chest pain with or without radiation to jaw or arms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What defines ‘stable’ angina?

A

Chest pain typical of angina is defined by:

  1. Constriction like pain in chest/neck/arm/jaw
  2. Brought on by physical activity
  3. Alleviated by rest or GTN within minutes

2/3 features indicate atypical angina pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What defines ‘unstable’ angina?

A

When the symptoms come on randomly whilst at rest

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is the First line investigation for angina?

A

CT Coronary Angiography (CTCA) - Gold Standard

Involves injecting contrast and taking CT images to highlight any narrowing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

When is CTCA indicated for Angina?

A

For atypical or typical angina pain or

ECG shows ischaemic changes in chest pain with < 2 angina features

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

List the second and third line investigations for stable Angina

A

2nd line: non-invasive functional imaging

3rd line: invasive coronary angiography

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

List 3 examples of Non-invasive functional imaging

A
  1. Myocardial perfusion scintigraphy with SPECT
  2. Stress ECHO
  3. MRI for regional wall motion abnormalities
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

List 4 other baseline investigations for Angina

A
  1. Physical Examination
  2. ECG
  3. FBC (check for anaemia)
  4. U&Es (prior to ACEi and other meds)
  5. LFTs (prior to statins)
  6. Lipid profile
  7. TFTs
  8. HbA1C and fasting glucose
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are the 4 principals of Angina management (RAMP)

A
  1. Refer to cardiology (urgently if unstable)
  2. Advise patient about diagnosis, management and when to call an ambulance
  3. Medical treatment
  4. Procedural or surgical interventions
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

First line treatment for stable Angina?

A

Beta blocker or rate limiting CCB

If not tolerated or symptoms not controlled, try switching to the other from above

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Second line treatment of stable angina?

A

Beta blocker + long-acting dihydropyridine CCB

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Third line treatment for Stable Angina?

A

Monotherapy with one of the following anti-anginals:

  1. Ivabradine
  2. Nicorandil
  3. Ranolazine
  4. Isosorbide mononitrate
22
Q

What procedure may patients with stable angina be eligible for?

What is the criteria for this

A

Re-vascularisation (with CABG or PCI) if:

  • symptoms are not controlled on optimal medical treatment AND
  • there is complex 3 vessel disease or
  • there is significant left main stem stenosis
23
Q

What causes ACS?

A

Thrombus from an atherosclerotic plaque blocking a coronary artery

24
Q

How is a diagnosis of ACS made?

A

ECG + serial troponins

25
Q

How is a diagnosis of STEMI made?

A

If there is ST elevation or new left bundle branch block on ECG

Must be in 2 consecutive leads (2 in chest, 1 limb)

26
Q

How is a diagnosis of NSTEMI made?

A

Raised troponin levels and/or

Other ECG changes (ST depression or T wave inversion or pathological Q waves)

27
Q

List 2 possible diagnosis if there are normal troponin levels and normal ECG

A
  1. Unstable angina
  2. Musculoskeletal chest pain
28
Q

How does ACS present?

A

Central, constricting chest pain associated with:

  • Nausea and vomiting
  • Sweating and clamminess
  • Feeling of impending doom
  • SOB
  • Palpitations
  • Pain radiating to jaw or arms
29
Q

What duration must symptoms persist to be regarded as ACS?

A

> 20 minutes

30
Q

Which patient group may not experience typical chest pain

A

Diabetics - “Silent MI”

31
Q

List 2 ECG changes seen in STEMI

A
  1. ST elevation in leads consistent with an area of ischaemia
  2. New Left Bundle Branch Block
32
Q

List 3 ECG changes which may be seen in an NSTEMI

A
  • ST segment depression
  • Deep T Wave Inversion
  • Pathological Q Waves (suggests deep infarct - late sign)
33
Q

State which artery supplies each heart area and which are the corresponding ECG leads

A
34
Q

List 5 investigations for ACS (not bloods)

A
  1. ECG
  2. CTCA - assess CAD
  3. Chest xray - for ddx
  4. Physical Examination
35
Q

List 4 things to investigate on bloods for ACS

A
  • FBC (check for anaemia)
  • U&Es (prior to ACEi and other meds)
  • LFTs (prior to statins)
  • Lipid profile
  • TFTs
  • HbA1C and fasting glucose
36
Q

List 2 other causes of raised troponins (not ACS)

A
  1. Chronic renal failure
  2. Sepsis
  3. Myocarditis
  4. Aortic dissection
  5. Pulmonary embolism
37
Q

What is the definitive treatment for an acute STEMI

A

Presenting within 12hrs of onset

  • Primary PCI (if available within 2 hours of presentation)
  • Thrombolysis (if PCI not available within 2 hours)
38
Q

What is PCI?

A

Catheter inserted via brachial or femoral artery into coronary arteries under xray guidance. Contrast injected to identify blockage

Treated with balloons to widen the gap or devices to remove or aspirate the blockage

Usually stent is put in to keep the artery open

39
Q

What is Thrombolysis?

What is the risk

A

Use of fibrinolytic medication that rapidly dissolves clots

Significant risk of bleeding

40
Q

List 2 examples of Thrombolysis

A
  1. Streptokinase
  2. Alteplase
  3. Tenecteplase
41
Q

What is the treatment of an Acute NSEMI?

A

MONA

  • Grace score ≤ 3 → Ticagralor and Fondapainux
  • Grace score > 3 → PCI (give Prasugrel or Clopidogrel prior)
42
Q

Should O2 be routinely given in NSTEMI treatment?

A

NO, only if O2 sats are dropping (ie. <95%).

43
Q

What score is used to assess for PCI in NSTEMI

A

GRACE Score

Gives a 6-month risk of death or repeat MI after having an NSTEMI

44
Q

Interpret the GRACE score and state who is eligible for PCI?

A
  • <5% Low Risk
  • 5-10% Medium Risk
  • >10% High Risk

Medium or high risk are considered for early PCI (within 4d of admission) for underlying CAD

45
Q

List 4 complications of an MI

(DREAD)

A
  1. Death
  2. Rupture of the heart septum or papillary muscles
  3. “Edema” (Heart Failure)
  4. Arrhythmia and Aneurysm
  5. Dressler’s Syndrome
46
Q

What is Dressler’s Syndrome? (ie. post MI syndrome)

How does it present?

A

Pericarditis which occurs 2-3 wks post MI

Presents with pleuritic chest pain, low grade fever and a pericardial rub on auscultation

47
Q

List 2 complications of Dressler’s syndrome

A

pericardial effusion and pericardial tamponade

48
Q

How is a diagnosis of Dressler’s syndrome made?

A
  1. ECG (global ST elevation and T wave inversion),
  2. Echocardiogram (pericardial effusion)
  3. Raised inflammatory markers (CRP and ESR)
49
Q

Management of Dressler’s syndrome

A

NSAIDs (aspirin / ibuprofen), more severe require steroids (prednisolone)

May need pericardiocentesis to remove fluid

50
Q

List the 6 secondary prevention medical managements for ACS

(6A’s)

A
  • Aspirin
  • Another antiplatelet: eg. clopidogrel or ticagrelor
  • Atorvastatin
  • ACEi
  • Atenolol (or other BB)
  • Aldosterone antagonist
51
Q

List 4 secondary lifestyle prevention measures

A
  1. Stop smoking
  2. Reduce alcohol consumption
  3. Mediterranean diet
  4. Cardiac rehabilitation
  5. Optimise treatment of other medical conditions (e.g. diabetes and hypertension)

Finals - CardioResp (18 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions