CHD Flashcards
What are the three characteristics of coronary arteries in CHD?
Narrow lumen, thickened hardened walls and a lack of ability for them to dilate effectively
What are three characteristics of the pain one may experience if they have stable angina?
heavy, squeezing or crushing pain
radiating to shoulder, neck, jaw or arms
may feel like indigestion
can last up to 30 minutes
may be caused by physical activity
may be a pattern
What should you do if you see someone on the street with stable angina?
tell them to stop and rest to correct O2 balance
Use a GTN sub-lingual spray
wait 5-10 minutes, if no change give another GTN
if no effect, call 000
What three drug classes do you use for stable angina?
Beta blockers, calcium channel blockers and long-acting nitrates
What is 1st line drug therapy for stable angina?
Beta blockers e.g. metoprolol without intrinsic sympathomimetic activity
What are two practice points for beta blockers? (2 marks)
do not stop abruptly or you may get an adrenergic surge
low dose and monitor
What are three factors to consider when using a BB? (3 marks)
- type of airway disease (COPD less risky than asthma)
- choice of BB- B1 selective preferred
- start with low dose, monitor and review
What is the second line treatment for stable angina? (2 marks)
CCB and nitrates
What types of Non dihydropyridine CCB is used fro stable angina?
rate limiting drugs such as verapamil and diltiazem
What is a risk of verapamil in stable angina?
can cause bradycardia and heart block
If using diltiazem in stable angina, what do you need to do?
monitor and use cautiously
What are 2 adverse effects of nitrates?
Hypotension, headache, gastric reflux
What is a contraindication of nitrates?
PDE5 inhibitors
What is the MOA of nitrates?
vasodilate which reduces preload by a lot and afterload by a lot to redistribute blood to ischemic zones
What are 3 practice points for nitrates?
reduce risk by having a nitrate free period of 4-8 hours per day
can be MR for 16 hours in a patch
ISDN tablets have effect of 6-8 hours
What do you use if you can’t use BBs, CCB or nitrates in CHD?
Nicorandil
What is the effect of nicorandil?
Produces venous and arterial dilation due to its nitrate moiety and its effect to open potassium channels in vascular smooth muscle
Name 3 adverse effects of nicorandil
headache, lethargy, nausea, dizziness, palpitation, flushing and myalgia
When would you not use Ivabradine?
if the HR was 70bmp or under
Do you use Ivabradine for heart failure or angina?
heart failure
What is perherxiline used for?
myocardial oxygen utilisation
What are the two main procedural options?
CABG and percutaneous coronary intervention (PCI)
What is first line antiplatelet treatment for stable angina?
low dose aspirin
Should you give statins to people with stable angina?
yes, regardless of cholesterol levels.
What is the differences in definitions of NSTEMI and STEMI?
NSTEMI is a nontransmural necrosis and a STEMI is a transmural necrosis
What is the difference between unstable angina and NSTEMI in terms of diagnosis?
Unstable Angina has negative biomarkers and a NSTEMI has positive biomarkers
What are 3 signs and symptoms of an ACS?
Sudden onset of symptoms
Central epigastric pain
discomfort
SOB
Nausea
Vomiting
Sweating
Fatigue
Clammy
List three tests for managing ACS?
ECG
Blood tests
- cardiac enzymes
- FBC
Creatinine and electrolytes
BGLs
What is the priority after a STEMI is diagnosed and why? (3 marks)
reperfusion of the myocardium because it reduces the risk of death and damage which can have long term consequences
Why might you not reperfuse a patient with ACS?
it is more than 12 hours after the symptom onset, the patient is asymptomatic and hemodynamically stable
Why do you reperfuse a patient with a STEMI?
it is a total blockage of the coronary artery
What are the two main options for reperfusion?
Percutaneous coronary intervention and fibrinolysis
What type of reperfusion do you use if a patient has NSTEACS (Non-STEMI acute coronary syndrome)?
PCI
How does a PCI occur?
Insertion of a catheter via radial or femoral artery and guided to heart. Xray control to visualise structures.
Angioplasty is carried out (inflation of balloon to compress plaque)
stent insertion
What are the two types of stents used in PCI
Drug eluting stents and Bare metal stents
How does a drug eluting stent work?
releases a cytotoxic drug to slow tissue regrowth
Name two antiplatelet therapies
low dose aspirin and clopidogrel
Name two antithrombin therapies
LMWH (enoxaparin and fondaparinux)
Bivalirudin
What is one fibrin selective drug for thrombolysis?
Fibrin selective- tenecteplase, reteplase and alteplase
What are three complications of ACS?
Arrhythmias, heart failure, mural thrombus, pulmonary embolism and infarct extension
What are three factors which make a NSTEACS patient high risk?
persistent chest pain/ discomfort
elevated cardiac enzymes
Systolic BP 90 or under
Previous CABG and PCI
Sustained ventricular tachycardia
Why is post ACS treatment important? (2 marks)
reduce early complications and hospital started meds may be seen as more important thus improving compliance
What are the fab four drug therapies for post-ACS therapy?
Antiplatelets
Beta blockers
ACEI (after BB stabilisation)
Statin
What is DAPT?
Dual anti-platelet therapy combining antiplatelets with MOAs.
What do you need to monitor in patients on ACEIs or ARBS?
k+
What factors affect CV risk?
Age, Aboriginal and Torres Strait Islander peoples, having a TIA recently, diabetes, Lipids, Systolic
what are 3 characteristics of the clinical presentation of stable angina?
Chest discomfort
Heavy squeezing or crushing pain which may radiate to shoulder, jaw, neck and arms
Triggered by physical activity
what are 3 characteristics of the clinical presentation of acute coronary syndrome?
SOB
N and V
Sweating
Fatigue
Central or epigastric pain
discomfort
What are 4 drugs/drug classes you use for stable angina?
Beta bockers
Calcium channel blockers
long acting nitrates
nicorandil
What are 2 adverse effects of beta blockers?
AEs- bradycardia, hypotension, orthostatic hypotension, nausea, diarrhoea, dyspnoea.
What are 2 precautions of beta blockers?
Contraindicated in severe and poorly controlled asthma. Bradycardia, can impair peripheral circulation, can mask clinical signs of hyperthyroidism
What are 2 adverse effects of calcium channel blockers?
Nausea, headache and dizziness
What are 2 precautions of calcium channel blockers?
can increase risk of muscle weakness and respiratory depression. Contraindicated in cardiogenic shock
What are 2 precautions of long acting nitrates
contraindicated in hypovolaemia and raised intracranial pressure
What are 2 adverse effects of long acting nitrates?
headache, flushing, palpitations, orthostatic hypotension, peripheral oedema
What are 2 adverse effects of nicorandil?
headache, nausea, dizziness, lethargy, palpitations, flushing and myalgia
What are 2 precautions of nicorandil?
associated with fistula formation in diverticula disease and contraindicated with PDE5 inhibitors
What do you use for confirmed ACS?
P2Y12 antagonists
What are 2 adverse effects of long acting P2Y12 antagonists?
bleeding and skin reactions
What is 1 precaution of long acting P2Y12 antagonists?
risk of bleeding
What are 4 cardioprotective drugs in ACS
Aniplatelets, beta blockers, AceIs and statins
What drug do you use post ACS, what are 2 side effects and what are 1 precaution?
eplerenone SE: hyperkalaemia, hypotension and dizziness. and Precautions- hyperkalaemia
What do you monitor with ACEIs?
Monitor potassium concentration and renal function
what do you monitor with eplerenone?
potassium levels
What can you do to encourage better heart health?
encourage them to weigh thmeselves daily, undertake physical activity, restrict salt, fluid and alcohol, smoking cessation.
