Ischaemic Heart Disease Flashcards
How would you diagnose stable angina? (3)
Chest pain on exertion
Relieved by GTN spray
Radiation of pain to jaw, neck, arm
How would you diagnose unstable angina? (3)
New-onset chest pain without exertion
Crescendo pattern (gets worse)
Not relieved by GTN spray
How would you manage angina non-pharmacologically?
Lifestyle changes: stop smoking, exercise, diet, control HTN + diabetes
How would you manage angina pharmacologically? (6)
SAINAB Statin - atorvastatin Aspirin (+PPI) Ivabradine Nitrates - GTN spray ACE-i - ramipril BB - bisoprolol
What medication would you give for angina if beta-blockers are contraindicated?
CCB - amlodipine, verapamil
How would you manage angina surgically? (2)
PCI - stent/ balloning
CABG - bypassing the occlusion and stenosis
What is a STEMI and what does it cause?
Complete occlusion of a major artery causing full-thickness heart damage
What would you see on ECG for a STEMI? (3)
ST elevation
Tall T waves
Pathological Q
What is an NSTEMI and what does it cause?
Partial occlusion of a major artery or complete occlusion of a minor artery causing partial-thickness heart damage
What would you see on ECG for an NSTEMI? (3)
ST depression
T inversion
Usually normal ECG (so diagnosed by troponins)
What would you see on the bloods for myocardial infarction?
Elevated serum troponin (T&I)
What are the clinical presentations of myocardial infarction? (4)
Chest pain/ pressure
Sweating
Nausea
SOB
How would you manage a myocardial infarction?
MONA Morphine Oxygen (if hypoxic < 95%) Nitrates - GTN spray Aspirin 300mg (+ clopidogrel)
After stabilisation of the MI, how would you proceed?
PCI = pt needs to get to the cath lab in < 120mins
OR
thrombolysis (ALTEPLASE)
