Cardiac conditions: Angina, ACS, Heart failure, Hypertension Flashcards
Difference in pathology between normal angina and Prinzmetal angina
Normal angina = gradual permanent narrowing of coronary arteries by fatty plaque
Prinzmetal angina = coronary artery spasms
What signs/ symptoms may make you suspect Prinzmetal angina over normal angina?
Prinzmetal tends to occur at night (vs normal)
Prinzmetal is not brought on by exercise or relieved by rest
What are pathological Q waves?
ie what do they look like?
What do they signify?
A dip in the Q wave (>0.02s) before the QRS complex. (the significant dip changes according to which lead)
Signify previous MI (absence of electrical activity)
Non-modifiable risk factors for Angina
- Diabetes
- Hypertension
- Anaemia
- Hypertrophic cardiomyopathy
- FH/ PMH of cardiovascular disease
Treatment of acute angina
GTN spray (repeat after 5min. If pain still present after 2nd dose, call 999)
Long-term treatment of angina
- B blocker OR CCB
- B blocker + CCB
- B blocker + CCB + 3rd drug
3rd drug = Long acting nitrate OR Ivabrandine OR Nicorandil OR Ranolazine
Medications for secondary prevention of CVD in angina
- Aspirin 75mg
- ACEi (if + diabetes)
+/- Statins, BP meds
Investigations to do for all ACS
FBC (anaemia can cause ACS)
BM (mortality indicator)
ECHO (check LV dysfunction)
Possible ECG features in NSTEMI
ST depression
T wave inversion
Pathological Q waves
Possible ECG features in STEMI
ST elevation
LBBB (new)
Pathological Q waves
What is the optimal timeframe for PCI (aka stent) to be done in STEMI
90min
Who should get PCI in STEMI
- Presents within 12h + PCI can be delivered within 2h of time that fibrinolysis could have been given
- Presents after 12h but evidence of continuing MI
- Symptoms of cardiogenic shock (regardless of time of presentation)
Follow up for pts who have been given thrombolysis/ fibrinolysis
- how to check if it worked
- what to do if it failed
Check if worked:
do ECG 60-90min later
If failed:
Send for PCI
Don’t repeat fibronolytic therapy
Why should a CXR be done in all NSTEMI/STEMI patients
Check for pulmonary oedema
and exclude differentials
Long term medications all patients should be on after NSTEMI/STEMI
- Antiplatelets (dual for first 12 months then single therafter)
- ACi
- B blocker
- Statin
+if LV ejection fraction 0.4 or less,
5. Eplenorone (aldosterone antagonist)
Antiplatelet options after an MI
Dual antiplatelets for 12 months
Then single antiplatelet if needed thereafter
DUAL
- Aspirin + clopidogrel OR
- Aspirin + ticagrelor
SINGLE
- Aspirin (most patients)
- Clopidogrel (if vascular disease)
ABCDE heart failure features on CXR
A: Alveolar oedema B: Kerley B lines C: Cardiomegaly D: Dilated upper lobe vessels E: Pleural effusion
Difference in pathophysiology of normal vs reduced ejection fraction heart failure
Reduced ejection fraction:
Failure of heart to constrict properly, reduced cardiac output
Normal ejection fraction:
Failure of heart to relax properly, increased filling pressure
Causes of reduced ejection fraction heart failure
Ischaemic heart disease
MI
Cardiomyopathy
Causes of normal ejection fraction heart failure
Hypertension
Constrictive pericarditis
Cardiac tamponade
Restrictive cardiomyopathy
Describe levels 1-4 of the NYHA score for heart failure
- No limitation in physical activity
- Mild SOB during ordinary activity
- Breathless after walking short distances. Comfortable only at rest
- Breathless even at rest
Management of acute heart failure
Furosemide 80mg
Management of reduced ejection fraction heart failure
- ACEi + B blocker
- Spironolactone
- Ivabradine/ Digoxin/ Sacubitril valsartan
What vaccines should be given to heart failure patients
- Flu vaccine (annually)
2. Pneumococcal vaccine
How to calculate mean arterial pressure (MAP)
Diastolic + 1/3 the difference between each reading
Eg with BP BP 105/60
MAP
= 60 + 1/3(45)
=75
What is Dressler’s syndrome
Pericarditis
Immune response after damage to heart tissue eg post trauma, post surgery, after heart attack
Drugs to manage Dressler’s syndrome
Aspirin
NSAIDs
Colchicine (anti inflammatory)
Management (with doses) of acute pulmonary oedema
LMNOP
Loop: furosemide 80mg IV (repeat if needed, max 1.5g a day) Morphine 2.5mg Nitrate: GTN 2.5mg Oxygen Position: sit patient upright
Blood pressure target in pt without diabetes
>80yo
<80yo
> 80yo: 140/90
<80yo: 150/90
Blood pressure target in diabetes
- without end organ damage
- with end organ damage
without end organ damage: 140/80
with end organ damage: 130/80
