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Cardiovascular > Heart Attack > Flashcards

Heart Attack Flashcards

1
Q

What are the characteristics of stable angina?

A
  • fixed stenosis
  • demand led ischaemia
  • predictable
  • safe
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2
Q

What advice is given to patients having an angina attack?

A

‘stop, sit spray’ - have one spray of GTN leave 5 mins and spray again - if pain persists call 999

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3
Q

Define acute coronary syndrome

A

any acute presentation of coronary disease

  • unstable angina
  • acute non-STEMI
  • STEMI
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4
Q

How does it differ from stable angina?

A
  • dynamic stenosis
  • supply led ischaemia
  • unpredictable
  • dangerous
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5
Q

Name six factors affecting plaque rupture

A
  • lipid content of plaque
  • thickness of fibrous cap
  • sudden changes in pressure
  • bending/twisting of artery
  • plaque shape
  • mechanical injury
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6
Q

What is the result of an occlusion in a stemi?

A

everything downstream from the occlusion starts to die

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7
Q

Can heart muscle regenerate?

A

Nope - it begins to scar

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8
Q

What is the result of scarring?

A

Dilation & aneurysm –> heart failure

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9
Q

Describe a classical presentation of a heart attack

A

Severe, central crushing chest pain radiating to the jaw and left arm. Associated with sweating and nausea

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10
Q

What must be present to diagnose a STEMI from an ECG?

A

> 1mm ST elevation in 2 adjacent limb leads

>2mm ST elevation in 2 contiguous precordial leads

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11
Q

What other changes may be seen on an ECG?

A

Q wave formation, T wave inversion

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12
Q

Other than ECG what other test can be done on a patient with a suspected MI?

A

Protein markers & enzymes

Troponin & Creatinine Kinase

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13
Q

What are the three types of troponin?

A

Troponin C - binds to calcium
Troponin I - binds to actin (deactivates actin after contraction)
Troponin T - facilitates contraction by binding to tropomyosin complex

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14
Q

In ischaemia what happens to troponin levels?

A

They rise 2-4 hours after an MI

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15
Q

What does elevated troponin signify?

A

Cardial necrosis

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16
Q

What is the early treatment for a suspected MI?

A 
Morphine ( and anti-emetic) 
Oxygen 
Nitrates
Aspirin 300mg (chewable) 
\+Clopidogrel 300mg
17
Q

When is thrombolysis administered?

A

If it is going to take more than 2 hours to get the patient to the cath lab for PCI

18
Q

What is an alternative to clopidogrel?

A

Ticegralor 180mg

19
Q

Name an anti-emetic

A

Metaclopramide

20
Q

Name four types of complications of an MI

A
  • Death
  • Arrhythmic complications
  • Structural complications
  • Functional complications
21
Q

What is the main, life threatening arrhythmic complication?

A

Ventricular fibrillation

22
Q

Name three structural complications

A
  • cardiac rupture (left ventricle)
  • ventricular septal defect
  • mitral valve regurgitation
23
Q

Name three functional complications

A
  • acute ventricular failure
  • chronic cardiac failure
  • cardiogenic shock
24
Q

What are the four classes of the killip classification?

A 
Risk of mortality 
I - no signs of HF 6% 
II - creps <50% 17%
III - creps >50% 38% 
IV - cariogenic shock 81%
25
Q

State the routine observations done on a patient who has had a recent MI

A
  • Pulse & BP
  • cardiac monitor
  • heart sounds
  • murmurs
  • crepitations
  • urine output
26
Q

When is a patient deemed to have a NSTEMI?

A

When the markers are high but there is no ST elevation on ECG

27
Q

What are the two key parts of the pathophysiology of UA and NSTEMI?

A

Thrombosis and vasoconstriction leads to reduced coronary blood flow

28
Q

What is the management for a patient with a NSTEMI?

A

Urgent revascularisation for patients at high risk
- anti platelet
(aspirin 300mg then 75mg/day for life, clopidogrel 300mg then 75mg/day for 12 months)
- antithrombin
(LMWH, glycoprotein IIb/IIIa antagonists)
- beta blockers, nitrates, calcium channel blockers, ACE inhibitor, statins)

29
Q

When is thrombolysis contraindicated?

A
  • surgery
  • bleeding/trauma
  • warfarin
  • haematoma

Cardiovascular (19 decks)

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