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BRS Y2 > Angina and MI > Flashcards

Angina and MI Flashcards

1
Q

What are the differential diagnoses for chest pain?

A

Pulmonary
Cardiovascular
Musculoskeletal

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2
Q

What does typical angina present with?

A

All three of the features:
Precipitated by physical exertion
Constricting discomfort in the front of the chest, in the neck, shoulders, jaw, or arms
Relieved by rest or glyceryl trinitrate (GTN) within about 5 minutes

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3
Q

What does atypical angina present with?

A

2 of the 3 features for typical angina along with atypical symptoms like GI discomfort, breathlessness or nausea

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4
Q

What features are likely to lead to a diagnosis of stable angina?

A

Pain that is continuous or prolonged.
Pain that is unrelated to activity.
Pain that is brought on by breathing.
Pain that is associated with dizziness, palpitations, tingling, or difficulty swallowing

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5
Q

What are the different types of angina?

A

Stable
Unstable
Variant (prinzmetal)

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6
Q

How long does stable angina usually last?

A

Under 5 mins

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7
Q

How long does unstable angina usually last?

A

Longer than 5 mins, can be prolonged

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8
Q

What type of angina is relievable by medicine?

A

Stable angina

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9
Q

What type of angina can lead to MI?

A

Unstable

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10
Q

What is pain inn variant angina caused by?

A

A spasm in the coronary arteries caused by exposure to cold, stress, smoking etc

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11
Q

What are some risk factors for angina?

A 
Alcohol use
Tobacco use
High BP
Family history
Gender
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12
Q

What are some tests performed for angina clinically?

A 
ECG
Coronary angiography
Exercise tolerance test
Lab tests
Troponin
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13
Q

What are troponin levels after heart damage?

A

They are elevated within a few hours of heart damage and remain elevated for up to two weeks

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14
Q

If troponin is normal, what is likely the pain is caused by and what is it less likely the pain is caused by?

A

More likely that the pain is due to stable angina

Less likely that the symptoms and chest pain are due to heart muscle damage

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15
Q

What are first line treatments for stable angina?

A

Short acting nitrates with beta blocker or CCB

Other options if heart rate is low or if symptoms remain uncontrolled

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16
Q

What type of MI occurs if the LCA and LAD are involved?

17
Q

What type of MI occurs if the LCx is involved?

18
Q

What type of MI occurs if the RCA is involved?

19
Q

What type of MI occurs if the RCA and LCx are Involved?

20
Q

What type of MI occurs if the LAD is involved?

21
Q

In anterior MI where is ST segment elevation found?

22
Q

In lateral MI where is ST segment elevation found?

A

I, avL, V5, V6

23
Q

In inferior MI where is ST segment elevation found?

A

II, III, aVF

24
Q

In posterior MI where is ST segment elevation found?

25
Q

In septal MI where is ST segment elevation found?

26
Q

What type of angina is STEMI?

27
Q

What is the management for STEMI?

A

Antiplatelet and add-on anti-ischemic/anticoagulant treatment
Reperfusion therapy (first line: primary PCI), alternative only if PCI unavailable, thrombolysis (if within the window) or rescue PCI if thrombolysis fails or CABG)
Long-term management

28
Q

What happens to the ST segment in STEMI vs NSTEMI

A 
STEMI= ST segment elevation
NSTEMI= ST segment depression and T wave inversion
29
Q

What is the main difference between STEMI and NSTEMI?

A

Pathophysiology:
STEMI= nearly always coronary plaque rupture resulting in thrombosis formation occluding a coronary artery
NSTEMI= incomplete thrombus formation

30
Q

What does incomplete thrombus formation is NSTEMI cause?

A

Blood and oxygen is not completely stopped but the restriction is so great that the oxygen content is used up quickly
In the distal arteries and arterioles, tissue death occurs as a result of oxygen starvation
The area affected is small, not enough to cause ST elevation but enough to cause minor ST/T wave changes and troponin elevation

31
Q

Describe the lumen in STEMI vs NSTEMI

A 
STEMI= completely blocked, no oxygen supply to tissue
NSTEMI= only partially blocked, even if plaque is unstable and ruptures theres enough lumen to allow blood flow that meets oxygen demand during rest
32
Q

What are the 2 acute coronary syndrome types and how are they differentiated on ECG?

A 
STEMI= will have ST elevation
NSTEMI= no ST elevation
33
Q

What is the difference between unstable angina and NSTEMI

A

NSTEMI= raised troponins

Unstable angina= normal troponins

34
Q

How do we decide how to treat unstable angina/ NSTEMI?

A

Perform a risk assessment
If they are low risk do a stress test and if positive do coronary angiography
If they are high risk invasive management is need eg CA, CABG, PCI

BRS Y2 (85 decks)

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