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PRE-REG-Thuri > CVD- ANGINA + HEART ATTACKS > Flashcards

CVD- ANGINA + HEART ATTACKS Flashcards

1
Q

What is coronary artery disease?

A

Atherosclerosis affects coronary arteries

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2
Q

What are the 2 types of angina?

A

Stable

Unstable

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3
Q

What are the 2 types of heart attacks?

A

STEMI

NON- STEMI

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3
Q

What is an acute coronary syndrome?

A

range of conditions related to sudden, reduced blood flow to the heart

Emergency

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4
Q

What is stable angina?

A

Ischaemic chest pain caused by exertion or emotional stress

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5
Q

What are the 2 symptoms of angina?

A

Chest pain

pain radiates to left arm, neck or jaw

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6
Q

Describe angina chest pain?

A

Tight, dull or heavy

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7
Q

What 4 medications are used in angina?

A

Short acting nitrate

Long-acting nitrate

BB

Vasodilator

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8
Q

What 2 categories are nitrates split into?

A

Short acting nitrate

Long-acting nitrate

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9
Q

List 2 short acting nitrates?

A

GTN

Isosorbide dinitrate

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10
Q

How is GTN administered?

A

Sublingual

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11
Q

When does GTN expire?

A

8 weeks

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12
Q

Give 3 examples of long acting nitrates?

A

GTN - transdermal patch

Isosorbide dinitrate - lasts 12 hrs: BD

Isosorbide mononitrate

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13
Q

What long acting nitrate is a MR preparation take once a morning?

A

Isosorbide mononitrate

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14
Q

What form of GTN is long acting?

A

Transdermal

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15
Q

Name 3 vasodilators involved in treating angina?

A

Ivabradine
Ranolazine
Nicorandil

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16
Q

What is MHRA regarding nicorandil?

A

Can cause skin, mucosa + eye ulcer

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17
Q

What is 1st line treatment for acute angina attacks?

A

GTN

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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

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19
Q

When to call 999 when getting angina?

A

after 2 doses of GTN - new update 2024

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20
Q

How long does sublingual GTN last?

A

20- 30 mins

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21
Q

What is 1st line for angina prophylaxis?

A

Beta blocker

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22
Q

What is an alternative treatment for angina prophylaxis?

A

Rate limiting CCB

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23
Q

What 2 drugs are used as second line in angina prophylaxis if BB fails?

A

BB+ CCB

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24
Q

Why do we avoid verapamil and beta blocker?

A

increased risk of heart failure.

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25
Q

What to give if beta blocker is contraindicated for Angina/ Heart attack?

A

CCB next

then
Vasodilator dual therapy

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26
Q

What to give if both BB + CCB contraindicated in Angina + heart failure?

A

Vasodilator monotherapy- e.g. Nitrate, ivabradine, ranolazine, nicorandil

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27
Q

What is the MOA of nitrates?

A

Potent coronary vasodilator

Reduces venous return and increases cardiac output.

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28
Q

What is a caution of using nitrates?

A

Tolerance can develop

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29
Q

What 2 types of nitrates can tolerance develop for?

A

Long acting nitrates

transdermal patches

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30
Q

What 3 things to do if tolerance is developing to nitrates?

A
  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
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31
Q

What to do if tolerance detected in MR and conventional tablets of isosorbide?

A

Take 2nd dose after 8 hours not 12 hrs.

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32
Q

How many times to give MR formulations of isosorbide mononitrate to avoid tolerance?

A

MR formulations of isosorbide mononitrate should only be given OD.

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33
Q

What are 3 SE of nitrates? (FHP)

A

Flushing

Throbbing headache

Postural hypOtension

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34
Q

What drug class is known to interact with nitrates to increase hypOtension? (severe)

A

Phosphodiesterase-type 5 inhibitors (e.g. sildenafil).

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35
Q

What other drug classes can increase hypotension when given with nitrates?

A

Anti-hypertensives (ACEi, ARB, BB, CCB)

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36
Q

What diabetic drug class can increase hypotension when given with nitrate?

A

SGLT2 inhibitors e.g. canagliflozin

37
Q

What other 2 drug classes can increase hypOtension with nitrate use?

A

Anit-depressants

Anti-parkinson drugs

38
Q

What is an acute coronary syndrome?

A

Unstable angina & MI

myocardial infarction with or without (STEMI or NSTEMI), + unstable angina.

39
Q

How is treatment described for acute coronary syndrome?

40
Q

What 5 drugs are given for LONG TERM TREATMENT OF unstable angina + non-stemi (CVE)?

A

High dose aspirin (lifelong) + high intensity statin

Clopidogrel for 12 months

Anti-angina drug (ACEi + BB)

41
Q

How long is clopidogrel given for unstable angina + non-stemi as part of secondary prevention?

42
Q

What 4 drugs are given as treatment for a STEMI?

A

Low dose aspirin + high intensity statin

Clopidogrel

ACEi/BB

43
Q

How long is clopidogrel given in STEMI patients?

44
Q

What is a Non-STEMI?

A

Partial blockage of the artery.
Mini-heart attack

45
Q

What is a STEMI

A

Complete + persistent blockage of the artery resulting in myocardial necrosis with ST-segment elevation seen on the ECG.

46
Q

What is worse Non-STEMI or STEMI?

47
Q

What is 1st line treatment of unstable angina + Non-STEMI in medical emergency?

A

Aspirin 300mg (chew or disperse)

GTN (sublingual PRN)

48
Q

How is aspirin taken in unstable angina + Non-STEMI?

A

Chew or disperse in water

49
Q

How is STEMI treated in emergency? (4 steps)

A
  1. Aspirin 300mg
  2. GTN- PRN
  3. IV diamorphine/morphine + metoclopramide

4.Oxygen- if needed (not routine)

50
Q

What is a non drug 1st LINE treatment for acute coronary syndrome?

A

Percutaneous coronary intervention (PCI)

51
Q

What is Percutaneous coronary intervention + when is it done?

A

non-surgical, invasive procedure.

Aim to relieve the narrowing or occlusion of arteries in heart.

Done in STEMI - asap

52
Q

What therapy is needed after having a coronary intervention?

A

Dual anti-platelet therapy

53
Q

What 2 drugs are used for dual anti-platelet therapy in unstable anginga, stemi/nstemi?

A

Aspirin- indefinitely

Clopidogrel -12 months

54
Q

How long to use clopidogrel when having metal stent?

55
Q

What is a coronary artery bypass graft coronary artery bypass graft?

A

surgical procedure used to treat coronary heart disease

56
Q

How long to use clopidogrel when having drug eluting stent?

57
Q

What is cardiac arrest?

A

Heart stops beating suddenly

58
Q

What is treatment in cardiac arrest?

A

CPR- emergency

59
Q

How man compression + breaths for CPR?

A

30 compressions

2 breaths

60
Q

What 2 drugs are given in cardiac arrest?

A

IV adrenaline

IV Amiodarone

61
Q

What is IV amiodarone used for?

A

Ventricular fibrillation

Pulseless ventricular tachycardia

62
Q

What is an alternative to IV amiodarone?

63
Q

What agent to give as antithrombin therapy in acute coronary syndrome?

A

Fondaparinux

64
Q

When is a Percutaneous coronary intervention required?

A

When a patient has stemi - 1st line

Can be done for NSTEMI too.

65
Q

When should PCI be done in STEMI?

A

Within 12 hours of symptom onset
And
within 120 minutes of the time when fibrinolysis could have been given

66
Q

When is a beta blocker given after a coronary syndrome?

A

when the patient becomes hemodynamically stable.

67
Q

When is beta blocker continued indefintely?

A

If they have a reduced left ventricular ejection fraction

68
Q

When can we stop beta blocker after 12 months?

A

FOR Those without reduced LVEF,

it may be appropriate to discontinue beta-blocker therapy after 12 months.

69
Q

What can be given as an alternative to beta-blocker therapy in patients who do not have pulmonary congestion or a reduced LVEF?

A

Rate limiting CCB- diltiazem or verapamil

70
Q

What antiplatelet is best used with aspirinif patient has had primary PCI after STEMI?

71
Q

Can aspirin be used alone and when in STEMI?

A

Aspirin alone may be appropriate for some patients with a high bleeding risk NOT undergoing a PCI.

72
Q

For patients undergoing primary PCI with radial access, what other anti-coagulant should be given?

A

Heparin unfractionated.

73
Q

If femoral access is needed After PCI, what unlicensed anti-anticoagulant given?

A

bivalirudin

74
Q

What is initial management for ACS?

A

1.Loading dose aspirin

2GTN - pain relief

3.Morphine - if suspecting MI

75
Q

What should be done if aspirin already given to patient before arrival at hospital?

A

Note that it has been given should be sent with the patient.

76
Q

Patients admitted to hospital after coronary syndrome should be monitored for?

A

hyperglycaemia

77
Q

When should patients receive insulin after ACS initial management?

A

If glucose greater than 11.0 mmol/litre

78
Q

What 4 drugs used in secondary prevention of CVD?

A

BB/ACEi

dual antiplatelet therapy

statin

79
Q

What DOAC is also used in combo either aspirin alone or with clopidogrel in preventing atherothrombotic events following an ACS with elevated cardiac biomarkers?

A

rivaroxaban

80
Q

How long to continue aspirin after ACS?

81
Q

What is 1st line for acute attacks in stable angina?

82
Q

What drug is contraindicated in Prinzmetal’s angina + decompensated HF?

82
Q

What drug is effective for Prinzmetal’s angina?

A

Normal CCB

amlodipine

83
Q

What is 1st line treatment for long term STABLE angina?

A

BB

or

rate limiting CCB - alternative if above contra

84
Q

What is treatment if BB and CCB contra in stable angina?

A

long-acting nitrate E.G., ivabradine, nicorandil, or ranolazine.

85
Q

What 2 drugs are given as Secondary prevention of cardiovascular events in STABLE angina?

A

low-dose aspirin + a low dose statin.

86
Q

If patient undergoing fibrinolysis, what is given at same time?

A

Antithrombin agent e.g. lmwh, fondaparinox

87
Q

Patients undergoing PCI in NSTEMI should be offered—-?

A

heparin (unfractionated) in the cardiac catheter laboratory [unlicensed], regardless of whether or not they have already received fondaparinux.

88
Q

What programme should ACS patients be offered?

A

cardiac rehabilitation programme including advice for lifestyle changes, stress management and health education

89
Q

For NSTEMI + unstable angina, there is myocardial necrosis in only —-?

PRE-REG-Thuri (44 decks)

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