Coronary artery disease Flashcards
What is the pathophysiology in brief of acute coronary syndromes?
Plaque rupture, thrombosis, inflammation
Differential for acute coronary syndrome?
Angina Peri / endo / myocarditis Dissection PE, pneumothorax, pneumonia Costochondritis GI: e.g. GORD, spasm Anxiety
What are the three divisions of ACS?
unstable angina
NSTEMI
STEMI
What are the features of NSTEMI on ECG?
ST depression and T wave inversion
When is the peak of troponin rise in MI?
24 hour
At what time period do you need to repeat troponin?
Trop elevated 3-12 hr, peaks at 24hr
What is the treatment for NSTEMI/UA?
medical
elective angio +- PCI/CABG
What is PCI?
Percutaneous Coronary Intervention (PCI, formerly known as angioplasty with stent) is a non-surgical procedure that uses a catheter (a thin flexible tube) to place a small structure called a stent to open up blood vessels in the heart that have been narrowed by plaque buildup, a condition known as atherosclerosis.
What is CABG?
Coronary artery bypass surgery restores normal blood flow to the heart by creating a “detour” (bypass) around the blocked artery/arteries. This is done by using a healthy blood vessel, called a graft. Grafts usually come from your own arteries and veins located in the chest, leg or arm. The graft creates a new pathway to carry oxygen-rich blood to the heart.
List four complications of MI
Death Pericarditis Dressler's syndrome Arrythmias Pump failure Embolism
What is the viability time frame of PCI?
<12 hr
Two complications of PCI?
bleeding, arrhythmia, emboli
What is the ECG criteria for thrombolysis?
ST elevation >2 chest leads or >2 limb leads
New LBBB
What are the contraindications for thrombolysis in STEMI?
AGAINST Aortic dissection GI bleeding Allergic reaction previously Iatrogenic: recent surgery Neuro: cerebral neoplasm or CVA Hx Severe HTN (200/120) Trauma, inc. CPR
Two complications of thrombolysis?
bleeding
stroke
arrhythmia
allergic reaction
Secondary management of MI?
ACEi: start w/i 24hrs of MI (e.g. lisinopril 2.5mg)
β-blocker: e.g. bisoprolol 10mg OD (or, CCB)
Cardiac rehabilitation (group exercise and info) / Heart Manual
DVT prophylaxis until fully mobile
Continue for 3mo if large anterior MI
Statin: regardless of basal lipids (e.g. atorvastatin 80mg)
What lifestyle advice would you offer for patient post-MI?
Stop smoking Diet: oily fish, fruit, veg, ↓ sat fats Exercise: 30min OD Work: return in 2mo Sex: avoid for 1mo Driving :avoid for 1mo
Patient with NSTEMI. What is their inpatient management from the beginning to discharge?
ECG Admit to CCU Oxygen IV access Hx + exam Antiplatelet- aspirin clopidogrel Anticoagulate Analgesia + antiemetics GTN Assess CDV risk: GRACE
In which conditions are there raised troponin levels?
STEMI, NSTEMI, myocarditis, PE, intense exercise
What are the different types of MI?
Type 1,2, 3, 4a, 4b, 5
What is type 1?
CORONARY ARTERY ASSOCIATED- spontaneous MI due to primary coronary event (coronary artery plaque rupture and formation of thrombus)
Type 2?
increaed oxygen demand or decreased oxygen supply- HF, sepsis, anaemia, hypertension
congestive HF, tachyarrhythmias, PE, sepsis, apical ballooning syndrome, anything that stresses the heart
ST elevation is observed in inferior leads. Which coronary artery is affected?
RCA
How can you determine post MI on ECG?
anterior lead is directly opposite and will see the opposite of any current generated at post wall i.e. post ST elevation=ant ST depression
