angina and MI

Question 1

what is stable angina

Answer 1

fixed stenosis due to atheroma, pain on exercise relieved by GTN spray

Question 2

what are acute coronary syndromes

Answer 2

cause unstable angina and MI’s, complelte or partial occlusion of coronary arteries, supply led ischaemia.

Question 3

when do plaques become particularly dangerous

Answer 3

when they rupture

Question 4

what factors favour plaque rupture

Answer 4

thin fibrous cap, sudden changes in pressure, lipid content, thickness of plaque

Question 5

what is the platelet cascade in thromboses

Answer 5

3 steps, adhesion, activation and aggregation. Plaque ruptures and platelets adhere to damages site via vWF. They then become activated and aggregate. this causes a blockage.

Question 6

what can stable angina develop into and what are the differences

Answer 6

unstable angina, pain at rest and lying down. GTN becomes less effective

Question 7

how does unstable angina differ from an MI

Answer 7

MI lasts over 30mins, no GTN relief

Question 8

what are the 2 types of MI

Answer 8

ST elevation MI (STEMI), non-ST elevation MI (NSTEMI)

Question 9

what are the symptoms of an MI

Answer 9

sweating, lasts longer than 30 mins, crushing central chest pain that can radiate to left arm. (full occlusion)

Question 10

what does a STEMI show on an ECG

Answer 10

elevated ST, or t wave inversion (ischaemia)

Question 11

what must the ST elevation show

Answer 11

1mm STE in 2 or more adjacent limb leads or 2mm in 2 or more precordial leads

Question 12

what leads show inferior MI and which artery is occluded

Answer 12

II, III, aVF, right coronary

Question 13

what leads show anteroseptal

Answer 13

V1-V4, LAD

Question 14

which leads show anterolaterl MI

Answer 14

V4-6 LAD or left circuflex

Question 15

what 2 proteins can be used for diagnosing an MI

Answer 15

CK enzyme and troponin

Question 16

which protein is better and why

Answer 16

troponin, specific to cardiac cells and CK peak production is 24 hours after MI

Question 17

what is immediate treatment of MI

Answer 17

morphine, oxygen, nitrate (GTN) if BP>90. Aspirin and clopidogrel

Question 18

what is the window of time needed for a PCI

Answer 18

90 mins

Question 19

what should be done if PCI can’t be done in 90 mins

Answer 19

thrombolysis

Question 20

what is dressler’s syndrome

Answer 20

post MI syndrome, can cause pericarditis, pericardial effusions

Question 21

what are troponin levels in normal people

Answer 21

negligible

Question 22

what can be done to prevent further MI’s

Answer 22

angioplasty and leave stent

Question 23

can ECGs be normal in MI’s

Answer 23

yes, if acute or NSTEMI

Question 24

what are some contraindications to thrombolysis

Answer 24

trauma, haemorrhage, recent surgery, stroke, hypertension

Question 25

what artery if often occluded in MI

Answer 25

LAD artery

Question 26

what are some coronary revascularisation procedures

Answer 26

coronary arterial bypass grafting (CABG), angioplasty (PCI)

Question 27

what is CABG

Answer 27

3 vessels on bypass (from radial artery and saphenous vein), attach distal to blockage

Question 28

what is involved in PCI

Answer 28

put patient on antocoag and antiplatelets. balloon stent

Question 29

what is better CABG or PCI

Answer 29

CABG

Question 30

what is the treatment for angina

Answer 30

1) GTN, 2) CBB or beta blockers 3) potassium channel activator nicorandil 4) long term nitrate ISMN

Question 31

which chest leads show posterior

Answer 31

V1-V2 = left circumflex

Question 32

what prophylaxis treatment can be given in MI’s

Answer 32

aspirin, clop, ACE/ARB, statins