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Hospital Based Medicine And Surgery > L16: Angina And ACS > Flashcards

L16: Angina And ACS Flashcards

1
Q

What are the 2 main arteries of the heart

A

Right main coronary artery

Left main coronary artery

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2
Q

What does the left main coronary artery branch into

A

Left anterioir descending artery

Circumfelx artery

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3
Q

Which area of the heart does the right coronary artery supply

A

Right ventricle inferioir wall of the left ventricle

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4
Q

Which area does the left anterior descending artery supply

A

Anterior lateral wall of the left ventricle

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5
Q

Which area does the cirucumflex artery supple

A

Posterioir and inferioir part of the heart

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6
Q

What is angina caused by

A

Narrowing or occlusion of the coronary artery by atheroma

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7
Q

What happnes to the cells in the heart when there are imbalances between myocardial oxygen supply

A

Ischaemia

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8
Q

What is the pathogenesis of angina

A

There is atherscloerisis deposition which causes narrowing of the vessel

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9
Q

If the athersclerotic plaque ruptures what happens to the blood vessel

A

Becomes occluded

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10
Q

What can occlusion of a vessel lead to

A

Stroke
Critical leg ischaemia
Myocardial infarction

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11
Q

What are the risk factors for atherosclerosis

A 
Hyperlipidemia e.g cholesterol
Hypertension
Diabetes: 1 and 2
Increasgin age
Male 
Genetics
Obesity
Infection
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12
Q

What are the clinical manifestations e.g diseases of ichaemic heart disease

A

Angina: stable (with exercise), unstable (at rest)
Myocardial infarction: st elevated or non st elevated
Cardiac death
Cardiac failure
Arrhythmia: atrial fibrillation, ventricular arrthymias

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13
Q

What are the differential diagnosis for angina

A

Musculoskeletal pain
Thoracic, cervical root pain
Peptic ulcer
Oesophageal reflux

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14
Q

What is the character of cardiac pain

A

Squeezing
Heavy
Retrosternal discomfort

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15
Q

Where is the location of cardiac pain

A

Mid thorax

Radiation to both arms or neck,Jaw

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16
Q

What is cardiac chest pain usually worsened by

A 
Exercise
Excitement
Stress
Cold weather
After meals
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17
Q

What is cardiac chest pain usually releived by

A

Rest

Nitrates e,g gtn spray

18
Q

What are other associated symptoms of cardiac chest pain

A

Dyspnoea
Sweating
Palpitation
Fatigue

19
Q

What are the clinical signs of angina or ischaemic heart disease

A 
Hyperlidipemia; arcus, xanthalama
Hypertension
Peripheral vascular disease
Diabetes
Anaemia
Murmus: aortic stenosis
20
Q

What is unstable angina

A

Chest pain that comes at rest and is prolonged cardiac chest pain

21
Q

What are the investigations of ischaemic heart disease

A 
12 lead ecg 
FBC: anaemia 
Lipids
Hba1c- diabetes
Thyroid function 
Ct coronary angiography
Stress testing e.g treadmill
Invasive coronary angiography
22
Q

What is a hallmark of myocardial ischaemia on an ECG

A

St segment depression

23
Q

What is a hallmark of myocardial infarction

A

ST elevation

24
Q

What are the features of an acute myocardial infarction (stemi) on a ECG

A

Normal
St elevation
Q waves
T wave inverted

25
Q

What is a STEMI

A

Myocardial infarction with st elevation

26
Q

What is the cause of STEMI

A

Occlusion of a coronary artery via a thrombus

27
Q

What will a stemi show on a ECG

A

St elevation
Q waves
T wave inversion

28
Q

How can we manage risk factors

A 
Smoking cessation
Hyperlipidemia- give statns
Lower hypertension
Dietary modification
Control diabetes
Physical acitvity
29
Q

What medical therapy can we give

A

Beta blockers: to slow the heart reate down
Nitrate: decrease coronary artery tone and allow vasodilation
Revascularisation: ballon angioplasty and stenting

30
Q

What is the medical therapy for stable angina

A 
Antiplatelet therpay
Short acting nitrates e.g gtn spray
Beta blocker
Long acting nitrate
Pottassium channel opener eg nicorandil
31
Q

What is nstemi

A

Non st elevatio myocardial infarction

32
Q

How is nstemi manageed

A

Aspirin
Antianginal therapy
Fondaparinux

33
Q

What are the management for revascularisation if NSTEMI risk is high

A

Coronary artery bypass graft- for left main coronary artery

PCI (angioplasty and stentig)- for patients with perisisten symptoms for st elevation MI

34
Q

What is the initial management of ACS

A 
MONAC
Morphine
Oxygen
Nitrate
Aspirin
Clopedigrol
35
Q

What is the gold standard treatment for STEMI

A

PCI- within 12 hours of symptoms onsent

36
Q

What is the secondary prevent management of ACS

A

Ace inhibitor- arb if intoleratd
Dual antiplatelet therapy
Statin
Beta blocker

37
Q

What is the management of stable angina

A 
GTN
Beta blocker
Calcium channel blocker 
Long acting nitrate
Antiplatelet therapy
38
Q

What changes are seen in nstemi on a ecg and a troponin blood test

A

St depression
T wave inversion
High troponin

39
Q

What ECG changes and troponin blood tests seen in unstable angina

A

Ecg normal

Troponin normal

40
Q

With which scoring system do we decide if people with nstemi need a angiography now or later on

A

Using the grace score

41
Q

What is the secondary prevention for all ACS

A

Statin
Dual antiplatelet therapy
Beta blocker
Ace inhibitor

42
Q

What is a angiography

A

X-ray to visualise the blood vessel

Hospital Based Medicine And Surgery (30 decks)

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