Coronary Heart Syndrome Flashcards
What is an atherosclerosis.
Fatty deposits (atheroma/plaques) build up on the arterial wall, causing the blood vessels to narrow, harden and eventually occlude.
What is the major risk factor for atherosclerosis.
(a) smoking
(b) unhealthy diet
(c) obesity
(d) high blood pressure
(a) smoking is the biggest risk factor. 36% increased risk.
What are the consequences of coronary heart disease?
Stable angina
Acute coronary syndrome
Acute coronary syndrome is a medical emergency.
(a) True
(b) False
True
Define acute coronary syndrome
Acute dysfunction or damage of the heart muscle due to myocardial ischemia and/or thrombosis secondary to arterial atherosclerosis.
Thrombosis is the rupture of atherosclerotic plaque, stimulating platelet aggregation and clot formation fully or partially blocking a blood vessel causing ischemia and infarction of the tissues distal.
(a) True
(b) False
True.
What is the difference between unstable angina and myocardial infarction.
Unstable angina is symptomatic myocardial ischemia at rest or with minimal exertion with minimal or no myocardial necrosis whereas myocardial infarction is acute myocardial injury with necrosis in a clinical setting consistent with myocardial schema.
Myocardial infarction can sometimes result in necrosis of myocardium.
(a) True
(b) False
(b) False it is with necrosis
Which one is more significant ST or NSTEMI and why.
ST elevation MI- is generally a full or very significant artery occlusion whereas an NSTEMI is a partial ischemic occlusion off one or more coronary arteries.
How is NSTEMI and ST elevation diagnosed.
Location is determined during angiogram or through ischemic imaging testing
ECG- guide for MI location and artery affected in ST-elevation presentation.
Which type of MI results in sudden cardiac death
(a) Type 1
(b) Type 2
(c) Type 3
(d)Type 4
(e)Type 5
What is the prime time you want to treat a patient presenting with and MI by.
(a) 120 minutes
(b) 160 minutes
(c) 80 minutes
(d) 45 minutes
(a) within 120 minutes because time is muscle
What are the common signs of heart attack.
Discomfort in chest such as pressure squeezing or pain.
Crushing pain central or left sided chest pain.
Pain or discomfort radiating to one or both arm (usually left), jaw, neck, back or stomach
Chest pain that increases in intensity or doesn’t go away with rest or (3) nitroglycerin.
Chest pain associated with nausea vomiting, and cold/clammy feeling.
Which one is not a symptom of heart attack
(a) Crushing sensation in central chest
(b) Chest pain or discomfort after exertion
(c) Crushing sensation in the left side
(d) Radiating pain in both arms
(e) pain not received after 3 GTN sprays
(B)
List the diagnosis required for MI
Urgent 12-lead ECG: T-wave flattening —→ ST-shift (elevation or
depression)—→ Q-wave formation
Blood tests – Cardiac enzymes- Troponin T/I
Patient X when he arrived to ward had normal troponin levels and 3 hours later there was rise in troponin level. How can you explain this.
There is a gradual release of troponin often 3-12 hours after onset of symptoms so he is in NSTEMI or STEMI. A false negative result is what happened here in this scenario.
What is the aim in acute management when you are waiting for blood test or ECG result to ascertain whether it is NSTEMI or STEMI. Explain why each agent is given. ANPAO
Aim: Symptom control + Restore myocardial perfusion
High Antiplatelet loading: inhibit thrombosis formation aft6er plaque rupture.
Nitrates: Increase perfusion of myocardium by dilating the coronary venules.
Pain relief: diamorphine/morphine IV= helps heart +reduce pain.
Antisickness: for the nausea and released myocardial cells IV metoclopramide (D2 antagonist)
Oxygen: if the saturation is low.
What is the management post diagnosis acute coronary syndrome: STEMI/NSTEMI
STEMI: PCI within 120 minutes or pharmacological thrombolysis within 12 hours.
NSTEMI: anticoagulation+ Antiplatelet (dual therapy)- routine elective PCI within 72 hours.
What is Percutaneous Coronary Intervention
- Ballon catheter is inserted into the artery.
- The ballon is inflated to expand the stent
- The ballon is deflated
- The catheter is removed and stent remains to hold artery open.
In STEMI early management was is the first step to manage patient pharmacological.
300-mg loading dose of aspirin as soon as possible and continue indefinitely.
In early management of NSTEMI and STEMI was is the dose aspirin used.
300-mg loading dose of aspirin
Please in detail provide the treatment management for STEMI
Which P2Y12 inhibitor has the highest bleeding risk.
(a) Prasugrel
(b) Ticagrelor
(c) Clopidogrel
(a) Prasugrel then ticagrelor (b)
Which P2Y12 inhibitor has the least bleeding risk associated.
(a) Prasugrel
(b) Ticagrelor
(c) Clopidogrel
(c) Clopidogrel least bleeding risk associated as second generation P2Y12 inhibitor, Prasugrel and Ticagrelor have higher bleeding risk associated as third generation P2Y12 inhibitors.
Please in detail provide the treatment management for NSTEMI/Unstable angina
If the value when using GRACE risk score to start management with angiography and Prasugrel + aspirin in NSTEMI/Unstable angina management.
A calculated mortality risk score of >3%.
Please provide in detail how you manage patient after NSTEMI/STEMI/Unstable angina.
Using the ABCDE acronym how should you manage patient post STEMI/NSTEMI/Unstable angina.
What is the loading dose for Ticagrelor in ACS.
180 mg STAT
How long can ticagrelor be used for post ACS.
1-3 years
What are common adverse effects associated with ticagrelor.
Breathlessness and conduction disease.
Prasugrel is contraindicated in ….
Stroke/TIA history or active bleed
What are the two factors when you consider prescribing Prasugrel
Age (>74 years) and body weight (60 kg)
What are common adverse drug effects associated with beta blocker.
Fatigue
Coldness if extremities
Hypotension
Bradycardia
Sleep disturbances
Contraindications/Cautions with Beta blockers
Cardiac blocks, pronounced bradycardia, acute asthma.
Select the best option for each scenario provided.
a. Tenectoplase
b. Streptokinase
c. PCI
d. Aspirin
e. Clopidogrel
f. Metclopramide
g. Promethazine
- 40-year-old comes with ST myocardial infarction that has lasted over 2 hours and is located in the highland. What intervention would you use.
- 35-year-old female is to be discharged with aspirin and what other agent for the prevention of arterial thrombosis.
- A 57 year old male with BMI 29 has come in feeling pain from the ST-elevation episode he was experiencing. What agent do you give.
- a.
- e.
- f. D2 antagonist is required.
Select the best option for each scenario
a. Bisoprolol
b. Ramipril
c. Losartan
d. Verapamil
e. Spironolactone
f. Ezetimibe
1. 40-year old female with reduced ejection fraction after MI. What agent should be given.
2. 55-year-old male with COPD who is on ACE-inhibitor, dual anti platelet therapy, statin and is requiring another agent added.
3. 60-year-old patient comes in dehydrated with increased creatinine and MH shows he was on spironolactone and one other agent. Which one could it be.
4. Patient cannot tolerate simvastatin.What agent could be given.
- (e) Monitor hyperkalemia and serum potassium
- (d) Beta blockers are contraindicated in COPD patients.
- (b) Ramipril increases risk of hyperkalemia.
- (f) Ezetimibe
