CV MI Flashcards
what is an MI?
Build up of atherosclerotic plaques which restrict arteries, reducing blood supply and oxygen to the heart
what is stable angina
predictable chest pain/pressure on physical exertion/emotional
initial tx for stable angina
and when can it be taken
Can be taken prophylactically/when symptoms arise
GTN dose to be taken at 5mins intervals
when is stable angina deemed med emergency?
If symptoms haven’t resolved after 2nd dose!
long term prevention of stable angina - 1st line?
beta-blocker (R-L CCB if contra)
long term prevention of stable angina - 2nd line?
b-blocker +normal CCB (amlodipine, lacidipine, etc)
NEVER B-B+R-L CCB
long term prevention of stable angina - 3rd line?
LIRN
long-acting nitrate (monomil)/ nicorandil/ivabradine/ranolazine
what side effects can nicroandil cause
GI+mucosal ulceration
also headaches
Angina further advice to pt
Healthy lifestyle measures
75mg aspirin + low dose statin
(not considered secondary prevention yet as stable angina not classed as CV event)
NITRATES
when should GTN SL tabs be discarded
8 weeks after opening bottle
GTN spray couselling - when to use
while sitting down
Patients should have nitrate free period to prevent tolerance
when should second dose of nitrate be given, after 1st dose
what bout for transdermal use?
Second dose of nitrate, give 8hrs after first dose (not 12), = 16hrs nitrate-free blood (8am, 4pm…)
Transdermal use: leave patch off for 8-12hrs
nitrates SEs? 3. FHD
Dizziness
Flushing
Headaches
-Elderly, caution risk of falls!
ACUTE CORONARY SYNDROMES include unstable angina, NSTEMI, STEMI
MAJOR RISK FACTORS?
Family history
Hypertension
Hypercholesterolaemia
Diabetes
Smoking
All syndromes- similar in initial/secondary treatment
why may Hypertension and Hypercholesterolaemia -> ACS?
can damage BVs in heart -> atherosclerotic plaques
Real-life scenario, ECG + biomarkers elevated, STEMI determined, action?
STEMI- Primary PCI (coronary reperfusion therapy) should be delivered ASAP within 2hrs
P.S . All 3 syndromes started on secondary prevention
ACS INITIAL MANAGEMENT, 3 THINGS?
LOADING DOSE ASPIRIN 300mg
PAIN RELIEF: GTN/IV morphine
O2 if needed
Monitor all patients for hyperglycaemia, >11mmol/L? Insulin!-> dose-adjusted infusion
NSTEMI/UNSTABLE ANGINA/STEMI DIFFERENCE?
-UNSTABLE ANGINA-
PARTIAL blockage of artery, not tissue death
-NSTEMI- PARTIAL blockage of artery+myocardial necrosis (dead cardiomyocytes->elevated cardiac troponin values)
ST zone of ECG is not elevated
-STEMI- COMPLETE blockage of artery causing myocardial necrosis
ST zone of ECG is elevated
non-ST vs st-elevated myocardial infarction!
STEMI requiring PCI (percutaneous coronary intervention) within 2 hours?
what is given and how
Give heparin if PCI is done through radial access
Long-term management? Prasugrel- secondary anti-platelet
what x4 drugs: SECONDARY PREVENTION FOR ALL ACS?
DABS
DUAL antiplatelet,
ACEi,
BB,
Statin
what dual antiplatelet as secondary prevention for ACS?
lifelong aspirin 75mg
12 months: clopidogrel, prasugrel (preferred if PCI), ticagrelor
what is given if ACEi contra in secondary prevention for ACS?
ARB
what strength and which statin to give in secondary prevention for ACS?
Atorvastatin 80mg, high strength
secondary prevention for ACS - BB may be discontinued when
after 12months in patients with LVEF
