Ischaemic Heart Disease and MI Flashcards
Co-morbidities associated with angina?
diabetes, PVD, MI, COPD
Primary prevention for MI is…
when there is no history of an MI - trying to prevent happening in first place
Secondary prevention for MI is…
when preventing further MIs after a history of having one.or more
GTN side-effects?
hypotension, headache
GTNs work as..
vasodilators as an NO donor
Calcium antagonists - dihydropyridines - can be given in angina, give some examples…
nifedipine, amlodipine
Side effects of CCB such as dihydropyridines?
ankle oedema
examples of b-blockers used in angina?
atenolol, bisoprolol
K-ATP channel openers used in angina example
nicorandil
Side-effects of rate limiting CCB in angina?
ankle oedema, heart block
CCB should not be used with?
b-blockers
long acting nitrates include?
isosorbide mononitrate
side effect of long acting nitrates include:
nitrate tolerance
Ivabradine acts on the ______ ______ to slow heart rate
funny current
Problem of ivabradine…
reduces exercise tolerance due to HR being unable to go above ~80bpm
T wave inversions are a sign of…
ischaemia
Extra drug used in NSTEMI treatment - not MONA+C
fondaparinux
Fondaparinux is…
Factor Xa inhibitor
Why are anti-coagulants given in AF?
to stop clots in L.atrium and thus prevent stroke or MI
typical anti-coagulants used in AF?
warfarin, rivaroxiban and apixiban
Spironolactone is…
an aldosterone antagonist
Side effect of spironolactone
hyperkalaemia
Ivabradine works in AF - true or false?
false
If a patient’s renal function is reduced on ACEIs, what is the first step?
stop and rechallenge at a lower dose - then consider other treatment if still intolerant
Mechanical complications of an Acute MI
VSD, MR (mitral regurgitation), Rupture
Angina can be described as…
pressing, squeezing, heaviness, a weight - on exertion, with stress, cold wind, after meals
intercostal pain can be described as…
dull, knifelike, stabbing, no pattern, at rest
DDx of chest pain
angina, MI, GI, musculoskeletal, pericarditis, pleuritic pain, pulmonary embolus, dissection of the aorta
Different methods of determining CHD
Exercise ECG, Perfusion Imaging, CT angiography, angiography
Pro of exercise ECG
cheap, reproducible, risk stratification
cons of exercise ECG
poor diagnostic accuracy, submaximal test
Pros of perfusion imaging
non-invasive, pharmacological stress in less mobile patients, more precision than ETT, risk stratification
Cons of perfusion imaging
radiation, false positives and false negatives
Pros of CT angiography
non-invasive, anatomical data and risk stratification
Cons of CT angiography
radiation, less precise than angiography, cost
Pros of angiography
gold standard, anatomical and risk stratification, follow on angioplasty
Cons of angiography
risk of death or stroke, radiation, contrast - renal dysfunction, rash, nausea
Pharmacological management of CHD
aspirin, b-blockers, statin, ACEI
What type of diagnosis is angina?
clinical - based off history and exam
Chronic stable angina is a sign of what sort of coronary plaque?
fixed stenosis with demand led ischaemia
Acute coronary syndromes include…
unstable angina, NSTEMI, STEMI
Unstable angina is a sign of what sort of coronary plaque?
waxing and waning stenosis with increased ischaemia
Possible ECG changes in STEMI
ST elevation, T wave inversion, Q waves, new onset LBBB, >1mm ST elevation in 2 adjacent limb leads, >2mm ST elevation in at least 2 contiguous precordial leads
Other markers for diagnosis of MI
creatinine kinase, troponin
MONA+C stands for…
morphine, oxygen, nitrates, aspirin and clopidogrel
Aim for treatment of MI
PCI (STEMI) and Thrombolysis or either
Door to balloon time in MI
90 mins
Arrhythmic complications of MI
V Fib
Structural complications of MI
Cardiac rupture, VSD, Mitral valve regurge, papillary, LV aneurysm, systemic emboli, Inflammation, Acute pericarditis, Dresslers syndrome
Functional Complications of MI
acute VFailure, chronic cardiac failure, cardiogenic shock