L16: Angina And ACS Flashcards
What are the 2 main arteries of the heart
Right main coronary artery
Left main coronary artery
What does the left main coronary artery branch into
Left anterioir descending artery
Circumfelx artery
Which area of the heart does the right coronary artery supply
Right ventricle inferioir wall of the left ventricle
Which area does the left anterior descending artery supply
Anterior lateral wall of the left ventricle
Which area does the cirucumflex artery supple
Posterioir and inferioir part of the heart
What is angina caused by
Narrowing or occlusion of the coronary artery by atheroma
What happnes to the cells in the heart when there are imbalances between myocardial oxygen supply
Ischaemia
What is the pathogenesis of angina
There is atherscloerisis deposition which causes narrowing of the vessel
If the athersclerotic plaque ruptures what happens to the blood vessel
Becomes occluded
What can occlusion of a vessel lead to
Stroke
Critical leg ischaemia
Myocardial infarction
What are the risk factors for atherosclerosis
Hyperlipidemia e.g cholesterol Hypertension Diabetes: 1 and 2 Increasgin age Male Genetics Obesity Infection
What are the clinical manifestations e.g diseases of ichaemic heart disease
Angina: stable (with exercise), unstable (at rest)
Myocardial infarction: st elevated or non st elevated
Cardiac death
Cardiac failure
Arrhythmia: atrial fibrillation, ventricular arrthymias
What are the differential diagnosis for angina
Musculoskeletal pain
Thoracic, cervical root pain
Peptic ulcer
Oesophageal reflux
What is the character of cardiac pain
Squeezing
Heavy
Retrosternal discomfort
Where is the location of cardiac pain
Mid thorax
Radiation to both arms or neck,Jaw
What is cardiac chest pain usually worsened by
Exercise Excitement Stress Cold weather After meals
What is cardiac chest pain usually releived by
Rest
Nitrates e,g gtn spray
What are other associated symptoms of cardiac chest pain
Dyspnoea
Sweating
Palpitation
Fatigue
What are the clinical signs of angina or ischaemic heart disease
Hyperlidipemia; arcus, xanthalama Hypertension Peripheral vascular disease Diabetes Anaemia Murmus: aortic stenosis
What is unstable angina
Chest pain that comes at rest and is prolonged cardiac chest pain
What are the investigations of ischaemic heart disease
12 lead ecg FBC: anaemia Lipids Hba1c- diabetes Thyroid function Ct coronary angiography Stress testing e.g treadmill Invasive coronary angiography
What is a hallmark of myocardial ischaemia on an ECG
St segment depression
What is a hallmark of myocardial infarction
ST elevation
What are the features of an acute myocardial infarction (stemi) on a ECG
Normal
St elevation
Q waves
T wave inverted
What is a STEMI
Myocardial infarction with st elevation
What is the cause of STEMI
Occlusion of a coronary artery via a thrombus
What will a stemi show on a ECG
St elevation
Q waves
T wave inversion
How can we manage risk factors
Smoking cessation Hyperlipidemia- give statns Lower hypertension Dietary modification Control diabetes Physical acitvity
What medical therapy can we give
Beta blockers: to slow the heart reate down
Nitrate: decrease coronary artery tone and allow vasodilation
Revascularisation: ballon angioplasty and stenting
What is the medical therapy for stable angina
Antiplatelet therpay Short acting nitrates e.g gtn spray Beta blocker Long acting nitrate Pottassium channel opener eg nicorandil
What is nstemi
Non st elevatio myocardial infarction
How is nstemi manageed
Aspirin
Antianginal therapy
Fondaparinux
What are the management for revascularisation if NSTEMI risk is high
Coronary artery bypass graft- for left main coronary artery
PCI (angioplasty and stentig)- for patients with perisisten symptoms for st elevation MI
What is the initial management of ACS
MONAC Morphine Oxygen Nitrate Aspirin Clopedigrol
What is the gold standard treatment for STEMI
PCI- within 12 hours of symptoms onsent
What is the secondary prevent management of ACS
Ace inhibitor- arb if intoleratd
Dual antiplatelet therapy
Statin
Beta blocker
What is the management of stable angina
GTN Beta blocker Calcium channel blocker Long acting nitrate Antiplatelet therapy
What changes are seen in nstemi on a ecg and a troponin blood test
St depression
T wave inversion
High troponin
What ECG changes and troponin blood tests seen in unstable angina
Ecg normal
Troponin normal
With which scoring system do we decide if people with nstemi need a angiography now or later on
Using the grace score
What is the secondary prevention for all ACS
Statin
Dual antiplatelet therapy
Beta blocker
Ace inhibitor
What is a angiography
X-ray to visualise the blood vessel
