Chest Pain Flashcards
what is angina
discomfort in chest due to NARROWING of coronary arteries and myocardial ischaemia
typical v atypical angina
criteria:
- discomfort in chest radiating to arms, neck, jaw
- worse on exertion
- relieved by GTN spray after 5 minutes
typical = all this criteria atypical = 2 of these
what is the first line treatment for stable angina
GTN spray, 1 dose, 5 minutes, 2nd dose, 5 minutes, then if not relieved = ambulance
what is the long term management for stable angina
1st line: beta blockers - bisoprolol, or CCB (amlodipine)
2nd line: BOTH these
3rd line: ivabradine, nicorandil or ranolazine
and also start on low-dose 75mg aspirin as secondary prevention of CVD
what do you do if no drugs are working for angina
CABG, or PCI if CABG not appropriate
what is unstable angina
angina that is severe and follows no patterns or triggers
what is variant angina
severe pain at night and early morning due to vasospasm of CA = narrowing due to SM contraction
what are the ECG changes in variant angina
ST elevation only during attack and increase in cardiac enzymes
how do you manage variant angina
nitrates, CCB, NOT beta-blockers
what is cardiac syndrome X
signs of myocardial ischaemia but with normal coronary arteries
how do you diagnose ACS
- high troponins
- symptoms of ischaemia
- echocardiography
- stress tests
- identify intracoronary thrombus by angiography
- ECG
what does an abnormal ECG in ACS show?
- transient ST elevation indicating an MI
- ST depression (this and t wave inversion is normally a NSTEMI)
- T wave inversion
what are the 3 complications of an MI?
decreased contractility = coronary vessel perfusion is reduced
atypical conduction = arrtyhmias
tissue necrosis = inflammation, pericarditis and papillary muscles are damaged
what is cardiac tamponade?
fluid or blood in the pericardial sac
what are the ECG signs of a STEMI
- ST elevation (and reciprocal depression in the others)
what are the pharmacological treatments for STEMI
oxygen
morphine
nitrates
300 mg aspirin
what are the time limits and surgical interventions for a STEMI
PCI within 12 hours if you can get there within 2 hours
if not - thrombolysis and rescue PCI if residual ST elevation
what is thrombolysis and how do you give it
alteplase, single IV bolus
what is the imaging used for an NSTEMI
ECG = should show ST depression transthoracic echo stress echo cardiac MRI CT coronary angiography
what is the surgical management for an NSTEMI or unstable angina
coronary angiography with follow on PCI within 96 hours of first admission
how do you treat an NSTEMI (non-emergency) - after an ECG shows
fondaparinux
300mg aspirin
clopidogrel longer term
what is the GRACE score and what does it include
indicates ischaemic risk in hospital and from 6m-3y
age, heart rate, systolic BP, ST segment deviation, troponins, cardiac arrest at admission
what is the CRUSADE score and how does it work
indicates bleeding risk
Baseline haematocrit, GFR, HR on admission, systolic BP, prior stroke, history of DM, signs of CHF on admission, female sex
what is the QRISK tool
estimating the 10 year risk of having a cardiovascular event in people who do not already have heart disease
what is the long term prevention after an MI for CV events
- aspirin for life
- dual anti-platelets for 12 months
- statins: atorvastatin 20mg if qrisk >10%
- beta-blockers if LVEF <40%
- ACE-I or ARB for all
when are troponins raised and why
in a STEMI or NSTEMI
because when cardiac muscle is damaged the membraine is disrupted so trop leaks out of cell and into blood
what is the commonest complication after an MI
arrythmias
what is v fib
when heart loses ability to contract and circulate blood to rest of the body
the cells are no longer conducted by the nodes, and fire randomly leading to ventricular wall spasming
blood stays in heart and cannot go to rest of the body
symptoms of v fib
collapse, no consciousness and no pulse
cyanosis
before, they may have MI symptoms bc lack of oxygen
risk factors for v fib
irritability to ventricular cells bc high Mg or high K or coronary artery blockage
scar tissue formation - MI, dead tissue replaced by protein scars, cardiomyopathy
what is v tach
high HR >100bpm arising from ventricles at rest
reduced time to fill between beats and hence no forward movement of blood flow from ventricles
symptoms of v tach and ECG changes
SOB, chest pain, palpitations, light headedness
wide QRS and tachycardia
what is SVT
tachycardia arising from AVN or above
types of SVT
A fib, paroxysmal SVT, atrial flutter and wolf-parkinson-white syndrome
symptoms of SVT
o Palpitations
o Chest pain
o Anxiety
o Short of breath
diagnosis of SVT
symptoms
ECG - no p waves
what is atrial fibrillation
atrial spasming signalling the AV node erratically which leads to irregular rhythm
ECG changes in a fib
distance in RR interval is different each time
no p waves
irregularly irregular
risk factors for a fib
decreased atrial tissue age inflammation enlarged atria due to HT, valve or lung disease hormonal abnormalities alcohol abuse
management of A fib
beta-blockers
anti-coagulant
what medication should you not give a patient with low blood pressure and chest pain
nitrates - vasodilator and hence would lower the blood pressure more
