HEART-ACS Flashcards
What can Acute Coronary Syndromes cause?
Blood vessel narrowing which causes Reduced oxygen delivery and cramp to begin with
Blood vessel occlusion which stops oxygen delivery (tissue death) causing pain and a loss of function
What do we need to diagnose ACS?
We need to know:
- The patient’s history
- The patients ECG- is it STEMI or NSTEMI
- Biomarkers (Has troponin been released by cardiac muscle? yes= we know there is damage)
What are the types of angina Pectoris?
(chest pain)
- Reversible ischaemia - restriction of the heart blood supply
- Classical angina -symptoms during exercise
- Unstable angina -symptoms during rest
Why is there pain with exertion in classic angina?
As the oxygen demand needed by the heart muscle is increased and cannot be supplied.
The pain is relieved by rest as the blood flow can return to normal.
How can we investigate angina?
- Look at the ECG resting and during exercise to show if there is ischaemia
- Angiography- where we inject a die to see if there is a blood vessel narrowing.
How do we treat angina?
- reduce the oxygen demands of the heart
- Increase oxygen delivery to the tissues (surgically)
- Non drug therapy
- Drug therapy.
How do we reduce the oxygen demands of the heart to treat angina?
Reduce afterload (the blood pressure)
Reduce preload (the venous pressure)
How do we increase oxygen delivery to the tissues surgically?
- Angioplasty - dilation of blocked and narrowed vessels.
- Stenting- Propping open of narrowed vessels
- Coronary artery bypass grafts- Bypass blocked or narrowed vessels.
What drug do we use to reduce myocardial infarction risk?
Aspirin
What drug do we use to reduce hypertension?
Diuretics or calcium channel antagonists
What drug do we use to reduce preload?
Nitrates.
Preload (venous pressure) is reduced by dilating coronary vessels.
What drug do we use for emergency treatment of angina ?
GTN Spray
What are the types of myocardial infarctions:
Spontaneous (First coronary event causes the heart attack i.e. plaque rupture)
Secondary to ischaemia (caused by inbalance in heart supply and demand)
Sudden death
MI from Treatment (angioplasty or bypass
What cardiac enzymes can be used to investigate a MI?
Troponin and Creatinine kinase.
How do we medically prevent another MI?
Aspirin
ACE inhibitors
Beta blockers.
How do we treat limb infarction?
Thrombolysis (Dissolving the clot that is blocking the tissue)
or
Amputation if acute limb necrosis occurs.
What is another name for a brain infarction?
A stroke.
What are TIAs
These are transient Ischaemic attacks. These are when platelet clots block the blood vessels to stop the brain working.
the patient can return to normal if they are removed quickly. This warns you that you are at risk of having a proper stroke, allowing you to deal with the risk before it happens.
What wave can we find in an ECG that tells us the patient has already suffered from a myocardial infarction?
A Q wave
Compare cardiac arrest patients to heart attack patients?
Heart attack patients can speak (they are still alive)
Cardiac arrest patients are dead.
