Diseases Flashcards
Presentation of Angina
Central chest pain on exertion + autonomic features
4 rare causes of angina
Anaemia
Tachyarrhythmia
Vasculitis
HCM
Cause of Prinzmental angina
Coronary artery spasm
1st -> 4th line maintenance therapy for angina
1st - Beta-blocker!! or CCB
2nd - other
3rd - + isosorbide mononitrate
4th - + nicorandil or ivabradine (decreases HR)
2 add on therapies for all angina patients
GTN spray
Aspirin
3 diagnostic tools for ACS
Cardiac biomarkers
Symptoms of ischaemia
ECG changes
3 cardiac biomarkers used for ACS - peak times
Troponin - high within 30 mins peak = 24-48hrs, baseline = 5-14d - if not +ve in 6hrs - not MI
CK-MB - cardio specific - high within 45 mins, peak = 24hrs, base = 72hrs
Myoglobin - highly sensitive, not specific
4 key ECG changes in ACS - general
ST elevation
T wave inversion
Q waves
New onset BBB
3 ECG criteria for STEMI
=/> 1mm in 2 adjacent limb leads
=/> 2mm in 2 contiguous precordial leads
New onset bundle branch block
2 people get silent MI’s
Elderly
Diabetics
4 abnormal MI presentations
Syncope
Epigastric pain + vomiting
Stroke
Acute confusion
4 lateral ECG leads + artery affected
I, aVL, V5 and V6
Left circumflex
3 inferior ECG leads + artery affected
II, III, aVF
Right coronary artery
2 septal ECG leads + artery affected
V1, V2
Left anterior descending
4 anterior ECG leads + artery affected
V1, V2, V3, V4
Left anterior descending
3 signs of HF
3rd HS
Raised JVP
Basal crepitations
9 DDx for MI
Angina Pericarditis Myocarditis Aortic dissection PE Reflux Peptic ulcer MSK Anxiety
Overview of STEMI management
MONA+T, PCI or fibrinolysis
PCI or fibrinolysis guidelines
Both within 12 hrs of symptom onset
PCI within 120 mins of presentation
Fibrinolysis if not within 120 mins of presentation
MONA+T
Morphine + anti-emetic (metoclopramide or cyclizine) Oxygen - target 94-98% (88-92% Aspirin - 300mg immediately Nitrates - if BP >90 Ticagerol 150mg with aspirin if STEMI
6 fibrinolysis contraindications
<3 weeks trauma/surgery/head injury PHx intracranial haemorrhage Intracranial malignancy <6 wks stroke Non-compressible punctures (liver biopsy, LP) Bleeding disorders GI bleed
1st line fibrinolysis
Tissue plasminogen activators (i.e. Alteplase)
Discharge MI drugs
ACEi
Beta-Blocker - as soon as haemodynamically stable
Dual antiplatelet therapy - aspirin + ___
Statin
3 NSTEMI management
Aspirin + anti-thrombin (IV eptifibatide or tirofiban) asap
PCI within 96 hrs
Driving advice - ACS
Angioplasty - 1wk
MI - 4 wks (no DVLA)
MI + bus, coach, lorry - 6wks + DVLA
Back to work after MI
2 months
10 MI complications - List
Cardiac arrest - VF Cardiogenic shock Tachyarrhythmia - VF/VT Bradyarrhythmia - AV node block Mitral regurgitation LV aneurysm Pericarditis LV free wall rupture Ventricular septal defect Dressler's
Post-MI cardiogenic shock management
Inotropes
Intra-aortic balloon
MI causing bradyarrythmias
Inferior - AV node ischaemia
Post-MI ST elevation persistance + LV failure
LV aneurysm
LV aneurysm complication
Clot formation => stroke
Post-MI Mitral regurgitation cause
Posterio-inferior MI - papillary muscle rupture
Post-MI early-to-mid systolic murmur
Mitral regurgitation
LV free wall rupture - presentation and %
Cardiac tamponade (raised JVP, pulsus paradox, diminished HS) 1-2 wks post-MI 3%
Ventricular septal defect - presentation and %
Pan systolic murmur + HF
1-2% in 1st week
Dressler’s syndrome presentation + management
Fever, pleuritic pain, pericardial effusion + raised ESR
NSAIDs
