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.
