HEART-ACS

Question 1

What can Acute Coronary Syndromes cause?

Answer 1

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

Question 2

What do we need to diagnose ACS?

Answer 2

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)

Question 3

What are the types of angina Pectoris?

Answer 3

(chest pain)

1. Reversible ischaemia - restriction of the heart blood supply
2. Classical angina -symptoms during exercise
3. Unstable angina -symptoms during rest

Question 4

Why is there pain with exertion in classic angina?

Answer 4

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.

Question 5

How can we investigate angina?

Answer 5

• 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.

Question 6

How do we treat angina?

Answer 6

• reduce the oxygen demands of the heart
• Increase oxygen delivery to the tissues (surgically)
• Non drug therapy
• Drug therapy.

Question 7

How do we reduce the oxygen demands of the heart to treat angina?

Answer 7

Reduce afterload (the blood pressure)

Reduce preload (the venous pressure)

Question 8

How do we increase oxygen delivery to the tissues surgically?

Answer 8

• Angioplasty - dilation of blocked and narrowed vessels.
• Stenting- Propping open of narrowed vessels
• Coronary artery bypass grafts- Bypass blocked or narrowed vessels.

Question 9

What drug do we use to reduce myocardial infarction risk?

Answer 9

Aspirin

Question 10

What drug do we use to reduce hypertension?

Answer 10

Diuretics or calcium channel antagonists

Question 11

What drug do we use to reduce preload?

Answer 11

Nitrates.

Preload (venous pressure) is reduced by dilating coronary vessels.

Question 12

What drug do we use for emergency treatment of angina ?

Answer 12

GTN Spray

Question 13

What are the types of myocardial infarctions:

Answer 13

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

Question 14

What cardiac enzymes can be used to investigate a MI?

Answer 14

Troponin and Creatinine kinase.

Question 15

How do we medically prevent another MI?

Answer 15

Aspirin

ACE inhibitors

Beta blockers.

Question 16

How do we treat limb infarction?

Answer 16

Thrombolysis (Dissolving the clot that is blocking the tissue)

or

Amputation if acute limb necrosis occurs.

Question 17

What is another name for a brain infarction?

Answer 17

A stroke.

Question 18

What are TIAs

Answer 18

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.

Question 19

What wave can we find in an ECG that tells us the patient has already suffered from a myocardial infarction?

Answer 19

A Q wave

Question 20

Compare cardiac arrest patients to heart attack patients?

Answer 20

Heart attack patients can speak (they are still alive)

Cardiac arrest patients are dead.