CVD- ANGINA + HEART ATTACKS Flashcards
1
Q
What is coronary artery disease?
A
Atherosclerosis affects coronary arteries
2
Q
What are the 2 types of angina?
A
Stable
Unstable
3
Q
What are the 2 types of heart attacks?
A
STEMI
NON- STEMI
3
Q
What is an acute coronary syndrome?
A
range of conditions related to sudden, reduced blood flow to the heart
Emergency
4
Q
What is stable angina?
A
Ischaemic chest pain caused by exertion or emotional stress
5
Q
What are the 2 symptoms of angina?
A
Chest pain
pain radiates to left arm, neck or jaw
6
Q
Describe angina chest pain?
A
Tight, dull or heavy
7
Q
What 4 medications are used in angina?
A
Short acting nitrate
Long-acting nitrate
BB
Vasodilator
8
Q
What 2 categories are nitrates split into?
A
Short acting nitrate
Long-acting nitrate
9
Q
List 2 short acting nitrates?
A
GTN
Isosorbide dinitrate
10
Q
How is GTN administered?
A
Sublingual
11
Q
When does GTN expire?
A
8 weeks
12
Q
Give 3 examples of long acting nitrates?
A
GTN - transdermal patch
Isosorbide dinitrate - lasts 12 hrs: BD
Isosorbide mononitrate
13
Q
What long acting nitrate is a MR preparation take once a morning?
A
Isosorbide mononitrate
14
Q
What form of GTN is long acting?
A
Transdermal
15
Q
Name 3 vasodilators involved in treating angina?
A
Ivabradine
Ranolazine
Nicorandil
16
Q
What is MHRA regarding nicorandil?
A
Can cause skin, mucosa + eye ulcer
17
Q
What is 1st line treatment for acute angina attacks?
A
GTN
18
Q
How to use GTN during angina?
A
Use sublingual
Sit down, take 1 dose, repeat every 5 mins
If symptoms don’t go away after 2nd dose. seek medical help
19
Q
When to call 999 when getting angina?
A
after 2 doses of GTN - new update 2024
20
Q
How long does sublingual GTN last?
A
20- 30 mins
21
Q
What is 1st line for angina prophylaxis?
A
Beta blocker
22
Q
What is an alternative treatment for angina prophylaxis?
A
Rate limiting CCB
23
Q
What 2 drugs are used as second line in angina prophylaxis if BB fails?
A
BB+ CCB
24
Why do we avoid verapamil and beta blocker?
increased risk of heart failure.
25
What to give if beta blocker is contraindicated for Angina/ Heart attack?
CCB next
then
Vasodilator dual therapy
26
What to give if both BB + CCB contraindicated in Angina + heart failure?
Vasodilator monotherapy- e.g. Nitrate, ivabradine, ranolazine, nicorandil
27
What is the MOA of nitrates?
Potent coronary vasodilator
Reduces venous return and increases cardiac output.
28
What is a caution of using nitrates?
Tolerance can develop
29
What 2 types of nitrates can tolerance develop for?
Long acting nitrates
transdermal patches
30
What 3 things to do if tolerance is developing to nitrates?
1. Leave patches off for 8-12 hrs if tolerance detected (GTN).
2. Take second dose after 8 hours not 12 hrs
3. Take MR isosorbide mononitrate OD
31
What to do if tolerance detected in MR and conventional tablets of isosorbide?
Take 2nd dose after 8 hours not 12 hrs.
32
How many times to give MR formulations of isosorbide mononitrate to avoid tolerance?
MR formulations of isosorbide mononitrate should only be given OD.
33
What are 3 SE of nitrates? (FHP)
Flushing
Throbbing headache
Postural hypOtension
34
What drug class is known to interact with nitrates to increase hypOtension? (severe)
Phosphodiesterase-type 5 inhibitors (e.g. sildenafil).
35
What other drug classes can increase hypotension when given with nitrates?
Anti-hypertensives (ACEi, ARB, BB, CCB)
36
What diabetic drug class can increase hypotension when given with nitrate?
SGLT2 inhibitors e.g. canagliflozin
37
What other 2 drug classes can increase hypOtension with nitrate use?
Anit-depressants
Anti-parkinson drugs
38
What is an acute coronary syndrome?
Unstable angina & MI
myocardial infarction with or without (STEMI or NSTEMI), + unstable angina.
39
How is treatment described for acute coronary syndrome?
Long term
40
What 5 drugs are given for LONG TERM TREATMENT OF unstable angina + non-stemi (CVE)?
High dose aspirin (lifelong) + high intensity statin
Clopidogrel for 12 months
Anti-angina drug (ACEi + BB)
41
How long is clopidogrel given for unstable angina + non-stemi as part of secondary prevention?
12 months
42
What 4 drugs are given as treatment for a STEMI?
Low dose aspirin + high intensity statin
Clopidogrel
ACEi/BB
43
How long is clopidogrel given in STEMI patients?
1 year
44
What is a Non-STEMI?
Partial blockage of the artery.
Mini-heart attack
45
What is a STEMI
Complete + persistent blockage of the artery resulting in myocardial necrosis with ST-segment elevation seen on the ECG.
46
What is worse Non-STEMI or STEMI?
STEMI
47
What is 1st line treatment of unstable angina + Non-STEMI in medical emergency?
Aspirin 300mg (chew or disperse)
GTN (sublingual PRN)
48
How is aspirin taken in unstable angina + Non-STEMI?
Chew or disperse in water
49
How is STEMI treated in emergency? (4 steps)
1. Aspirin 300mg
2. GTN- PRN
3. IV diamorphine/morphine + metoclopramide
4.Oxygen- if needed (not routine)
50
What is a non drug 1st LINE treatment for acute coronary syndrome?
Percutaneous coronary intervention (PCI)
51
What is Percutaneous coronary intervention + when is it done?
non-surgical, invasive procedure.
Aim to relieve the narrowing or occlusion of arteries in heart.
Done in STEMI - asap
52
What therapy is needed after having a coronary intervention?
Dual anti-platelet therapy
53
What 2 drugs are used for dual anti-platelet therapy in unstable anginga, stemi/nstemi?
Aspirin- indefinitely
Clopidogrel -12 months
54
How long to use clopidogrel when having metal stent?
1 month
55
What is a coronary artery bypass graft coronary artery bypass graft?
surgical procedure used to treat coronary heart disease
56
How long to use clopidogrel when having drug eluting stent?
6 months
57
What is cardiac arrest?
Heart stops beating suddenly
58
What is treatment in cardiac arrest?
CPR- emergency
59
How man compression + breaths for CPR?
30 compressions
2 breaths
60
What 2 drugs are given in cardiac arrest?
IV adrenaline
IV Amiodarone
61
What is IV amiodarone used for?
Ventricular fibrillation
Pulseless ventricular tachycardia
62
What is an alternative to IV amiodarone?
Lidocaine
63
What agent to give as antithrombin therapy in acute coronary syndrome?
Fondaparinux
64
When is a Percutaneous coronary intervention required?
When a patient has stemi - 1st line
Can be done for NSTEMI too.
65
When should PCI be done in STEMI?
Within 12 hours of symptom onset
And
within 120 minutes of the time when fibrinolysis could have been given
66
When is a beta blocker given after a coronary syndrome?
when the patient becomes hemodynamically stable.
67
When is beta blocker continued indefintely?
If they have a reduced left ventricular ejection fraction
68
When can we stop beta blocker after 12 months?
FOR Those without reduced LVEF,
it may be appropriate to discontinue beta-blocker therapy after 12 months.
69
What can be given as an alternative to beta-blocker therapy in patients who do not have pulmonary congestion or a reduced LVEF?
Rate limiting CCB- diltiazem or verapamil
70
What antiplatelet is best used with aspirinif patient has had primary PCI after STEMI?
Prasugrel
71
Can aspirin be used alone and when in STEMI?
Aspirin alone may be appropriate for some patients with a high bleeding risk NOT undergoing a PCI.
72
For patients undergoing primary PCI with radial access, what other anti-coagulant should be given?
Heparin unfractionated.
73
If femoral access is needed After PCI, what unlicensed anti-anticoagulant given?
bivalirudin
74
What is initial management for ACS?
1.Loading dose aspirin
2GTN - pain relief
3.Morphine - if suspecting MI
75
What should be done if aspirin already given to patient before arrival at hospital?
Note that it has been given should be sent with the patient.
76
Patients admitted to hospital after coronary syndrome should be monitored for?
hyperglycaemia
77
When should patients receive insulin after ACS initial management?
If glucose greater than 11.0 mmol/litre
78
What 4 drugs used in secondary prevention of CVD?
BB/ACEi
dual antiplatelet therapy
statin
79
What DOAC is also used in combo either aspirin alone or with clopidogrel in preventing atherothrombotic events following an ACS with elevated cardiac biomarkers?
rivaroxaban
80
How long to continue aspirin after ACS?
forever
81
What is 1st line for acute attacks in stable angina?
GTN
82
What drug is contraindicated in Prinzmetal's angina + decompensated HF?
BB
82
What drug is effective for Prinzmetal's angina?
Normal CCB
amlodipine
83
What is 1st line treatment for long term STABLE angina?
BB
or
rate limiting CCB - alternative if above contra
84
What is treatment if BB and CCB contra in stable angina?
long-acting nitrate E.G., ivabradine, nicorandil, or ranolazine.
85
What 2 drugs are given as Secondary prevention of cardiovascular events in STABLE angina?
low-dose aspirin + a low dose statin.
86
If patient undergoing fibrinolysis, what is given at same time?
Antithrombin agent e.g. lmwh, fondaparinox
87
Patients undergoing PCI in NSTEMI should be offered----?
heparin (unfractionated) in the cardiac catheter laboratory [unlicensed], regardless of whether or not they have already received fondaparinux.
88
What programme should ACS patients be offered?
cardiac rehabilitation programme including advice for lifestyle changes, stress management and health education
89
For NSTEMI + unstable angina, there is myocardial necrosis in only ----?
NSTEMI
