Cardiology Flashcards
What is acute coronary syndrome?
[1] unstable angina
[2] NSTEMI and STEMI - non ST elevated MI and ST elevated MI
Pathiophysiology of an MI
occurs when there is insufficient blood supply to the heart (or none at all)- can cause muscle damage
is a medical emergency
This is usually due to coronary artery disease, atherosclerotic plaques in the coronary arteries cause progressive narrowing of the lumen, and symptoms occur when blood flow does not provide adequate amounts of oxygen to the myocardium when oxygen demand increases.
symptoms
crushing chest pain - may radiate to neck jaw back patient appears pale, sweaty and grey Nausea and vomiting systolic BP less than 90 Shortness of breath may present with arrhithymas and syncope
what is levines sign?
clenched fist held over the chest to describe ischemic chest pain
List as many risk factors…
FH of MI Age Men - 2-3x more common lack of exercise high fatty diet high cholesterol hypertension hyperlipidemia diabetes smoking alcohol high levels of coagulation factors stress at work elevated CRP
what would be visible on an ECG
tall tented t waves first
tgeb ST elevated
T flattening inversion
broad q WAVES
additional test results
elevated troponin
how would you manage this patient?
GTN spray 2.5-5mg
coronary angioplasty
thrombolytics
R eassurance O xygen M orphine A nticoagulants N itrates Clopedigrel Emoxiprin
what can you give if HR is fast and what is value for it
HR >100bpm
metropolol
but not if hypotensive, bradycardiac, asthmatic or has HF
when would you consider IV insulin infusion
if glucose is >11mmol
prevention measure
lifestyle factors- altering diet, losing weight, doing exercise statin beta blocker ACEi antiplatelet medications -clopidogrel
when can they drive and return to work
1 and 2 month respectively
what is dressler syndrome?
how can it be treated
POST MI syndrome using 2-10 weeks later
recurrent fever , chest pain and effusion
due to autoantibodies to the heart muscle
NSAIDs and steriods
what percentage have no pain? what percentage of deaths in the UK?
20%
30%
Hypertension…
what is it?
a long term condition, also known as high blood pressure, it is a major risk factor for CVD
arterial BP is elevated
risk factors for hypertension? (6) including conditions (5)
include high salt intake fatty diet lack of exercise alcohol smoking age
can be caused by other conditions such as pregnancy cushing syndrome conns syndrome coarctation of the aorta
diagnosis occurs how?
BP checks
usually an incidential finding
can check protein in urine - Albumin:creatinine ratio
confirm with 2-3 measurements
ambulatory BP monitoring -frequent measurements 2 per hour, use average of 14 atleast
management of these patients
[1] lifestyle and education - alter diet, lose weight, stop smoking and cut down alcohol, diabetic control
[[2] if this does not work, consider an ACEi or an ARB as a first line (Younger than 55)
unless over 55 and/or afro-Caribbean than use CCB
if this does not work consider increasing dose and combination of the 2.
Ace inhibitor+Calcium Channel blocker
if still resistant, then consider thiazide duiruetic Ace inhibitor+ thiazide-type diuretic
then consider ACEI + CCB +TD
if still no success with combination and TD then cosndier adding spironocolone or using beta blocker
Consider seeking specialist advice
when can beta blockers be used
child bearing female (or potential)
contraindication with ARB or ACEi
Angina— define angina?
angina is myocardial ischemia and presents with central chest pain/tightness/heaviness
what makes it better and wrose?
where may it radiate?
intiated by exertion
relieved with rest/GTN within about 5 minutes
mat radiate to left arm, neck, jaw or back.
what is unstable angina?
increased frequency of angina
unpredictable
rest makes no difference -still pain
