heart attack and angina Flashcards
cardiogenic shock
inadequate systemic perfusion as a result of cardiac dysfunction
chest pain differential diagnosis
MI PE aortic dissection gastric reflux peptic ulcer pain oesophageal spasm biliary colic MSK injury MSK nerve root pain pericarditis pleuritic pain
angina investigations
exercise testing
perfusion imaging
CT angiography
angina reducing risk ad relieving symptoms
drugs - aspirin, beta blockers, statins, ACE inhibitor
lifestyle - stop smoking, exercise, good diet
CABG, PCI
heart attack risk factors
smoking stress alcohol drug abuse hypertension age gender high cholesterol obesity family history
chronic stable angina
fixed stenosis demand led ischaemia predictable safe patients should, stop sit down and spray GTN
acute coronary syndrome
any acute presentation coronary artery disease
covers a spectrum of conditions
acute MI
ST elevation
non ST elevation
same pathogenic trigger
stable plaque to unstable
acute coronary syndrome
dynamic stenosis supply led ischaemia unpredictable dangerous spontaneous plaque rupture
factors affecting plaque rupture/fissure
lipid content of plaque
thickness of fibrous cap
sudden changes in intraluminal pressure or tone
bending and twisting of an artery during each heart contraction
plaque shape
mechanical injury
platelet cascade
initiation adhesion activation release of activators surface receptors amplification of platelet activation activation triggers inflammatory cascade complete occlusion muscle is damaged and losses function resulting in heart failure
MI history
severe crushing central chest pain - gripping, squeezing, heavy, crushing
radiating to jaw and arms especially the left
similar to angina, more severe, not relieved by GTN
ECG changes in acute MI
ST elevation - in 2 adjacent limb leads, at least 2 contiguous precordial leads, new onset bundle branch block
t wave inversion - first day, old MI
Q waves - first day, old MI
anatomical site of MI
inferior - 2, 3, AVF
anterior - V1-V6
anteroseptal - V1-V4
anterolateral 1, AVL, V1-V6
MI diagnosis
cardiac enzymes - creatinine kinase
protein marker - troponin, highly specific for cardiac muscle damage, can detect tiny amounts of myocardial necrosis, may be normal at presentation
