Angina and Acute Coronary Syndromes Flashcards
In Angina you experience a ___ pain due to ____
visceral ; myocardial hypoxia
Differentials for anginal pain:
oesophageal spasm, biliary colic, peptic ulcer, GORD, MSK, pericarditis, pleuritic pain
angor animi =
fear of dying
Reperfusion causes _____ and a ______ (which can cause ______)
both are a cause of death post-MI
arrhythmias
lengthened QT region -> polymorphic VT may lead to re-entrant tachycardias
Post-MI can get cardiogenic shock if:
delayed presentation
multivessel disease
complications eg. mitral regurg, VSD, rupture
Gold-standard test for ischaemic CVD
angiography - done before get angioplasty
anatomical and risk stratification
Angiography involves inserting a catheter into the ___/___ into the _____ inject contrast and then ____
wrist/groin
coronary ostium
x-ray
Non-invasive but less precise form of imaging the coronary arteries than angiography if calcium is present
CT angiography
Anterior MI shows up as STE in _____ ECG leads
Reciprocal ST depression in ___
V1-6
III and avF
Anteroseptal MI shows as STE in ____ ECG leads
V1-4
Septal ECG leads =
V1-2
Anterolateral MI shows STE in ____ ECG leads
avL, I, V3-6
Inferior MI shows STE in ____ ECG leads
II III avF
Lateral ECG leads =
I, avL, avR, V5, V6
Inferior ECG leads =
II, III, avF
Anterior leads =
V3-4
Stable angina =
fixed stenosis
demand-led ischaemia
stop sit and GTN spray
ACS = (3)
unstable angina
NSTEMI
STEMI
ACS is ____ led ischaemia due to ___
supply-led
obstruction - subtototal/complete - dynamic stenosis
old/new plaques are more likely to rupture due to ____ cap
new
thin fibrous cap
Signs of MI that can be seen in an ECG
STE, T inversion, pathological Q waves
Diagnosis of a STEMI needs
> =1mm STE in 2 adjacent limb leads
OR
=2mm STE in >=2 contiguous precordial leads
Cardiac enzyme that peaks 24hr after MI
also in muscle and brain
CK - creatinine kinase
Treatment of STEMI
MONAC IV Morphine O2 if hypoxic Nitrate (GTN IV) if >90mmHg Aspirin and clopidogrel 300mg \+anti-emetic
no acute complete occlusion of coronary vessel because plasmin performs intravascular thrombolysis =
NSTEMI
ST depression indicates
ischaemia
For NSTEMI treatment =
immediately - heparin
long term - aspirin and clopidogrel for 3 months
possibly tirofiban
asap (outpatient) coronary angiogram and revascularisation
Aim to defibrillate cardiac arrest within ___
3 minutes
How to measure rate of irregular HR on ECG
no. QRS in 30 boxes x 10
ECG leads that are normally inverted
avR, V1,2,3
If ____ = left axis deflection
avF inverted
If _____ = right axis deflection
I inverted
If _____ = extreme right axis deflection
I and avF inverted
To increase pre-load in cardiac arrest
IV fluid
raise legs
No pulse, unresponsive and non-breathing
cardiac arrest
Pulse, unresponsive and non-breathing
pulmonary arrest
In cardiac arrest assess O2 delivery factors by :
ABG/pulse oximetry - SaO2
Full blood count - Hb
ECG/pulse - HR
CPR = ___compressions ___ deep at a rate of ___
then ___ rescue breaths lasting ___
Position =
30 compressions 5-6cm 100-120/min
2 breaths ; less than 10s
middle of the chest
Shockable heart rhythms
pulseless VT
VF
Non-shockable heart rhythms
PEA
asystole
ALS =
(___ -> __CPR ) repeat then on ___ shock give ___ and then after every alternative shock
Shock -> 2min
3rd
adrenaline
for PEA / asystole (may have p but no QRS) give __ adrenaline every ___mins/___cycles
1mg
3-5mins
2 cycles
4Ts and 4Hs of reversible causes of cardiac arrest
hypoxia - hypovolaemia
hypo/hyperkalaemia - hypothermia
thrombosis - tension pneumothorax
tamponade - toxins
Bag ventilation / laryngeal mask airway (LMA) / supraglottic airway device (SAD) for
hypoxia in cardiac arrest
After cardiac arrest transfer to ___
critical care area
Cardiomalacia perforens =
mushy wall post MI and can burst => tamponade / septal defect
To diagnose pathological pulmonary oedema must get patient to ___ and then listen to chest again
cough - post-pertussive inspiratory crackles
elderly get secretory crackles that go away when cough / move
A(n) ____ infarction is caused by a blockage in the LAD
This shows as STE in leads ____
anteroseptal
V1-V4
A(n) ____ infarction is caused by a RCA blockage
This shows as STE in leads ___
inferior
II III avF
A(n) ___ infarction is caused by circumflex occlusion
Shows as____ on ECG
posterior
tall R and ST depression in V1-2
PE most commonly causes ___ on ECG
Rarely causes characteristic _____
sinus tachy
SIQIIITIII pattern - deep S waves in I
pathological Q in III
inverted T waves in III
