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Cardiovascular > Ischaemic Heart Disease > Flashcards

Ischaemic Heart Disease Flashcards

1
Q

What are the classifications of acute coronary syndrome?

A

Stable angina

Unstable angina

NSTEMI

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2
Q

What is the difference between stable and unstable angina?

A

unstable occurs at rest

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3
Q

Describe the presentation of acute coronary syndrome

A

Central crushing chest pain

  • Radiation to neck and left arm

Sweating

Dyspnoea

Pallor

Palpitations

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4
Q

What investigations are used in the diagnosis of acute coronary syndrome?

A

ECG

  • T wave inversion
  • ST depression

Troponin and CK

FBC

  • Anaemia worsens ischaemia

LFTs

U&Es

  • Electrolyte abnormalities can cause arrythmias

TFT

  • Hyperthyroidism can cause arrythmias
  • Hypothyroidism can cause coronary artery disease

Lipids

Glucose, to rule out DKA

Echo

CXR

CT coronary angiogram

Exercise tolerance test, produces symptoms

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5
Q

What is the first line investigation for stable chest pain (after ecg)?

A

CT coronary angiogram

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6
Q

What biomarker is most useful for determining re-infarction after initial insult?

A

CK, as it remains elevated for 3-4 days following infarction, whereas troponin remains elevated for 10 days, so can be used to determine if reinfarction between 4-10 day window

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7
Q

What is the acute management of acute coronary syndrome?

A

MONA greets chest pain at the door

  • IV morphine
  • Oxygen, if <90%
  • IV nitrates
  • 300mg aspirin, or 75mg if going on to lifelong

Anti-coagulants

  • For NSTEMI instead of thrombolysis
  • Ticagrelor, if not high bleeding risk
  • Clopidogrel, if high bleeding risk
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8
Q

What is the long-term management of acute coronary syndrome?

A

B Blocker for symptom relief (bisoprolol 5mg)

CCB, add if angina is not controlled by B blocker

Dual anti-platelet therapy

  • 75mg aspirin
  • Clopidogrel

GTN Spray, to abort angina attacks as and when required

Statins (atorvastatin 80mg)

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9
Q

What medication is used in dual anti-platelet therapy?

A

Aspirin

Clopidogrel

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10
Q

Describe angina grade 1

A

Angina on strenuous or prolonged exertion

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11
Q

Describe angina grade 2

A

Slight limitation of ordinary activity, angina on moderate activity

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12
Q

Describe angina grade 3

A

Marked limitation of ordinary activity, angina on mild activity

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13
Q

Describe angina grade 4

A

Unable to carry out activities without angina, may occur at rest

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14
Q

What are the causes of a STEMI?

A

Descreased coronary perfusion/ischaemia

Arrythmia

Coronartery vasospasm

Anaemia

HF

Valvular Disease

Hyperthyroidism

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15
Q

What are the risk factors for STEMIs?

A

HTN

Obesity

Alcohol

Hypercholesteremia and hyperlipidaemia

>Age

Male

FM <50

Smoking

Diabetes

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16
Q

Describe the presentation of a STEMI

A

Acute onset

Chest pain

  • Central
  • Crushing
  • Radiates to left arm, neck and jaw

Sweating

Dyspnoea

Palpitations

Dizziness

Pallor

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17
Q

What investigations are used in STEMI diagnosis?

A

ECG

  • ST elevation in 2 continuous leads
  • ST depression in NSTEMI
  • Pathological Q waves suggest prior MI

Biomarkers

  • Troponin
  • Creatine Kinase

ECHO

  • Assess myocardial damage
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18
Q

What is the short term management of a STEMI?

A

Aspirin

P2Y12-receptor antagonist

  • Ticagrelor
  • Prasugrel

LMWH/unfractionated heparin if going to cath lab

Cath Lab/coronary intervention within 120 minutes of presenting to hospital

  • Primary Percutaneous Coronary Intervention (PCI)
  • Coronary Artery Bypass Graft (CABG)

Thrombolysis, offered within 12 hours if unable to get to lab within 120 minutes

19
Q

Give contraindications for thrombolysis

A

Active internal bleeding

Recent haemorrhage, trauma or surgery

Coagulation and bleeding disorders

Intracranial neoplasm

Stroke < 3 months

Aortic dissection

Recent head injury

Severe hypertension

20
Q

What is the long-term management of a STEMI?

A

Dual anti-platelet therapy

ACEI

Statin

B-Blocker

GTN Spray

Digoxin

21
Q

What drug is given before percutaneous coronary intervention?

A

Glycoprotein IIb/IIIa receptor antagonist/anti thrombin drugs

Such as fondaparinux

22
Q

What score determines if percutaneous coronary intervention is required?

A

GRACE (Global Registry of Acute Cardiac Events)

23
Q

Name some complications of STEMIs

A

Ventricular fibrillation

  • Cardiac arrest and death

Cardiogenic shock

LV Aneurysm

  • Ischaemic damage weakens myocardium, creating a bulge
  • Persistent ST elevation following MI but without chest pain

Mitral regurgitation

  • Capillary muscle rupture

Pericarditis/Dressler syndrome

  • Common within first 48 hours of a transmural MI

Cardiogenic shock

  • Ejection fraction of the heart decreases due to dysfunctional ventricular myocardium

Chronic heart Failure

  • Ventricular myocardium is dysfunctional

Acute/flash pulmonary oedema, secondary to mitral regurgitation

Cardiac Tamponade

Ventricular septal defect

24
Q

What is the most common cause of death following MI?

A

Ventricular fibrillation

25
Q

When should verapamil be used in acute coronary syndrome management?

A

Only use if monotherapy (not with B Blocker) due to risk of bradycardia

26
Q

What is the mechanism of action of statins?

A

Decreases intrinsic cholesterol synthesis

27
Q

Give an example of a statin

A

Simvastatin

28
Q

Give adverse effects of statins

A

Myopathy

Liver impairment

Intracerebral haemorrhage

29
Q

Give contraindications for statins

A

Pregnancy

Macrolides, must be temporarly stopped, causes >CK

  • Clarithomycin
  • Erythromycin
30
Q

When should statin treatment be discontinued?

A

Treatment with statins should be discontinued if serum transaminase concentrations rise to and persist at 3 times the upper limit of the reference range

31
Q

When should statin treatment be started?

A

QRISK score >=10

32
Q

Give side effects of nitrates

A

Headache

Hypotension

Tachycardia

Flushing

33
Q

Give a contraindication of nitrates

A

Hypotension

34
Q

Describe infarct location

A

Anterior, left anteior descending artery

Lateral, circumflex artery

Inferior, right coronary artery

Posterior, left circumflex and right coronary

35
Q

What ecg signs are seen in posterior infarction/STEMI?

A

Tall R waves V1-V2

Broad r waves

ST depression

36
Q

What system is used to determine risk post MI?

A

Killip class

37
Q

Give features of killip class 1

A

No clinical signs of HF

38
Q

Give features of killip class 2

A

Lung crackles, S3

39
Q

Give features of killip class 3

A

Frank pulmonary oedema

40
Q

Give features of killip class 4

A

Cardiogenic shock

41
Q

What are the DVLA rules post MI?

A

Unable to drive for 4 weeks, or 1 week if successfully treated with angioplasty

42
Q

Which NSAID is contraindicated in cardiovascular disease?

A

Diclofenac, due to increased risk of cardiovascular events

43
Q

Give features of costochondritis

A

Tenderness on palpation

Pain on inspiration

Cardiovascular (12 decks)

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