Heart 4b

Question 1

Signs if myocardial infarction

Answer 1

Pain-severe, immobilising chest pain not relieved by rest and medication
Sympathetic nervous system stimulation- diaphoresis, vasoconstriction of peripheral blood vessel
Increase cardiac symptoms
Nausea and vomiting
Fever
Elevated inflammatory markers

Question 2

Atypical presentation mi

Answer 2

1/3 of pts may not present classic signs

Atypical presentation is increasingly likely in particular patient groups

Question 3

Differentail diagnosis of causes of chest pain

Answer 3

Ischaemic cardiovascular causes
Non- cardiovascular causes of chest pain
Non-cardiovascular causes

Question 4

Ischaemic cardiovascular causes

Answer 4

Acs
Stable angina
Aevere aprtic stenosis
Tachyarrhythmia

Question 5

Non-ischaemic cardiovascular causes of chest pain

Answer 5

Aortic dissection
Pulmonary embolism
Pericarditis and myocarditis
Gastrointestinal cause

Question 6

Non-cardiovascular causes

Answer 6

Musculoskeletal causes
Pulmonary
Other aetiologies

Question 7

Management of chronic stable angina

Answer 7

Life changes
Drug therapy
Cardiac catherisation

Question 8

Drug therapy chronic stable angina

Answer 8

Nitrates- long and short
Angiotensin converting enzymes(ace 1) or angiotensin 11 receptor blockers - result in vasodilation and reduced blood volume 
Beta blocker- elevated lv dysfunction 
Calcium channel blockers
Lipid lowering drugs

Question 9

Cardiac catherisation

Answer 9

Increasing symptoms

If blockage is amenable to intervention then coronary revascularisation with percutaneous coronary intervention (pci)

Question 10

Diagnosis of acs

Answer 10

Initial clinical evaluation and management on presentation to ed
Initial rapid evaluation and dd 
12 lead ecg
Blood samples for biomarkers
Oxygen therapy 
Initial pharmacology

Question 11

Drug therapy for acute coronary syndrome

Answer 11

Anti-ischaemic therapies
Antiplatelet therapy
Anticoagulant therapy
Intravenous direct thrombin inhibitors

Question 12

Anti- ischaemic therapies

Answer 12

Oxygen
Nitrates
Beta-blockers
Opioid analgesia

Question 13

Antiplatelet therapy

Answer 13

Aspirin
P2y12
Glycoprotein 11b/111a

Question 14

Anticoagulant therapy

Answer 14

Heparin and enoxaparin

Question 15

Intravenous direct thrombin inhibitors

Answer 15

Bivalirudin

Question 16

Alternate cholesterol lowering agents

Answer 16

Monoclonal antibodies

Pcsk9 inhibitors

Question 17

Invasive and non-invasive management options for acute coronary syndrome

Answer 17

Percutaneous coronary intervention
Thrombolytic therapy
Coronary artery bypass graft
Transmyocardial laser revascularisation

Question 18

Primary percutaneous coronary intervention

Answer 18

First line of treatment for patients with confirmed mi

Goal is to open up artery within 90 minutes of arrival at facility that has an interventional cardiac catherisation

Question 19

Coronary surgical revascularisation indicated for

Answer 19

Fail medical management
Have left main disease
Are not candidates for pci
Have had pci and continue to have chest pain
Have diabetes
Are expected to have longer-tern benefits with cabg than with pci

Question 20

Off pump vs on pump coronary artery bypass

Answer 20

Primary hypothesis was that off pump cabg would be associated with fewer major clinical events in the short term than on-pump that benefits of off-pump cabg would be maintained in the long term
No cost difference

Question 21

Nursing care and considerations following coronary re-vascularisation

Answer 21

Patient assessment 
Monitor exg
Monitor patient for arrhythmias or other changes
Check vascular observation 
Monitor insertion site
Administer medication as ordered 
Administer stool softeners
Discharge teaching/education

Question 22

Thrombolytic therapy

Answer 22

Availability and rapid administration in facilities without cardiac catherisation
Aims to stop the infarction process by dissolving the thrombus in the coronary artery and perfusing the myocardium
Given asap
Mortality is reduced by 25 percent if administered within the first 6 months
Patient selection is important as bleeding is a major complication

Question 23

Transmyocardial laser revascularisation

Answer 23

Involves the use of high energy laser therapy to create channels in the hearrcto allow blood to flow to ischemic areas
Procedure is performed during catherisation or inctheathre as a thorcotomy
An optioncfor patientswith advanced cad who are nit candidates for cabg and have persistent angina after medical therapy