Angina, unstable angina, AMI Flashcards
Preventative health areas in angina management
Smoking Alcohol Diet - low fat and cholesterol Weight control HTN management DM management Lipid management
Type of activity recommended for angina patients
Encourage activity for 20 mins per day
Encourage activity up till symptoms begin, then rest
Advice to patient in terms of acute angina attacks
Rest - sit down at onset of symptoms 1-2 sprays GTN Wait 5 mins If symptoms / pain persists... 1-2 more sprays If pain not gone, call ambulance
(indicitive of unstable angina or AMI)
Management of unstable angina / AMI in general practice setting
O2 via face mask 8L/min
Obtain IV access
GTN spray - 1-2 sprays IF BP >100mmHg systolic
Aspirin 300mg STAT
Morphine IV - start at 1mg per min up to 15 mg (usually 2-10mg –> titrate up till good effect)
ECG monitoring*
Typical features of full thickness AMI in ECG
Broad Q wave (>1mm)
Deep Q wave –> usually >25% depth of R wave
T wave Inversion
ST elevation (typical STEMI)
Describr normal patterns of Troponin cardiac enzymes in:
Angina
Unstable angina
AMI
Always get troponins for baseline ASAP
In AMI:
Starts rising after 3-6 hours
Peaks at 10 hours
Persists for several days
Troponins also positive in unstable angina
Negative in stable angina
Describe pattern on CK cardiac enzymesin in:
Angina
Unstable angina
AMI
In AMI:
Starts rising 6-8 hours from onset of pain
peaks at 20-24 hours
Usually returns to normal by 48 hours
Can be positive in unstable angina
Negative in stable angina
Management of AMI in emergency
Immediate attendance from superiors if suspect
Call mobile coronary care unit
Aim: Referral to cath lab within 60 minutes from onset of pain
If no access to cath lab, consider use of thrombolytic - refer to specialist / consultant for this decision
Intranasal O2 high flow
Intubate if necessary
Aspirin 300mg stat if no contra-indications
IV access
Take bloods for cardiac enzymes - troponins* and CK
Bloods for FBC, urea and electrolytes,
Continuous ECG monitorins
IV morphine - 1mg per minute, titrate up to max 15mg till pain relieved adequately
Echo
Discharge drugs post-AMI, and when should they be started?
Beta blockers - started within 12 hours
Consider ACEI - started within 24 hours - for LV failure
Aspirin low dose +/- clopidogrel
Statin
Consider need for warfarin - if evidence of thrombus on echo
Management post-the event in hospital
Manage patient & family anxiety, provide education
Bed rest for 24-48 hours
Check potassium and magnesium
Early mobilisation to full activity over 7-12 days
Light diet
sedation
Beta blockers - atenolol or metoprolol
Warfarin if indicated - e.g. if evidence of thrombus on echo
ACEI - if LV failure, to prevent remodelling
Monitor psychological issues
Management post-discharge from AMI
Rehab program Continued couselling and education No smoking Weight reduction Diet modifications Alcohol limitations Regular exercise
Continue BBs for at least 2 years
Continue ACEI
Aspirin low dose daily
Warfarin where indicated for at least 3 motnhs
How would LV failure in/after AMI present itself?
Basal crackles on auscultation (pulmonary oedema)
Extra (3rd or 4th) heart sounds
X-ray changes - pulmonary oedema - diffuse whiteness
What special additional treatments must you make sure you include if LV failure present?
Oxygen
Diuretic
ACEI
What is Post-AMI syndrome, and how is it treated?
Occurs weeks or months after AMI - usually ~6 weeks
Features: pericardial rub, fever, pericardial effusion (autoimmune response)
Treatment: Anti-inflammatories (with caution) –> E.g. Ibuprofen. Avoid those that can increase risk of bleeding too much…
Patient 2 days post AMI presents with pericardial friction rub - what is happening, how is it treated?
Pericarditis.
Anti-inflammatories - Ibuprofen
Avoid anticoagulant NSAIDS
