Lecture 3 - Angina and ACS Flashcards
Define coronary syndrome
Obstruction of or reduction in coronary blood supply and subsequent cardiac ischaemia (reduced supply to the heart)
Define stitch analogy
Reduced blood to muscles when exercising, blood diverted elsewhere, so pain is felt
Define a STEMI
Complete occlusion of the artery
No blood supply getting to that area
Severe pain on LHS of chest radiating to the arm to the upper jaw
Nausea, dizziness and sickness
Uncomfortable for the patient
Rise in cardiac markers - troponin
Define NSTEMi
Partial occlusion of the artery
Still some blood supply to the area
Severe pain
Rise in cardiac markers - troponin
Define unstable angina
Some occlusion of the parties
Chest pain at rest
Can be uncomfortable
Define stable angina
Chest pain occurs through the exertion and should not occur at rest
What ECG changes and cardiac markers occur in an STEMI?
ST-segment elevation
Raised cardiac markers
What ECG changes and cardiac markers occur in NSTEMI?
ST/T-abnormalities or none
Raised cardiac markers
Define arteriosclerosis
Hardening of the arteries
Formation of atheroma - an inflammatory cascade of endothelial damage, infiltration of immune cells and fatty tissue infiltration of immune cells and fatty tissue infiltration
Name a cardiac marker of ACS
Troponin - detected 3-12 hours after the onset of pain
Name factors which suspect ACS
Cardiovascular risk factors (e.g. smoking, age, BP, diabetes and obesity or family history of a cardiac event)
Presenting symptoms - chest pain, radiation in left arm to the jaw
Signs and Investigations
Differential diagnosis - indigestion or chest pain?
Are there other causes of ECG changes?
Can also be associated with Inflammation or conditions such as pericarditis or trauma to the cardiac failure
How is a pharmacist involved in ACS and angina?
NMS - purpose, side effects and their management, doses
Discuss medicines management at home
Post-discharge medication review
Smoking cessation
Healthy lifestyle advice
Cardiac rehabilitation - reduce chances of events reoccurring
Describe the immediate management of angina/ ACS?
analgesics and antiemetics
GTN, isosorbide dinitrate, and beta-blockers - Lower GR and reduce chest pain
Oxygen - optimise oxygen around the body
STAT dose of Antiplatelets
=> Aspirin 300mg
=> Prasugrel 60mg, Clopidogrel 300mg or ticagrelor 180mg prevent further platelet aggregation
=> Bivalirudin or tirofiban - considered as GPllb/lla
VTE prophylaxis - fondaparinux
Blood tests
Define percutaneous coronary intervention
Metal/ polymer lattice - allows blood to flow through the artery
Balloon used to inflate the stent and open it up so it pushes the fatty deposits away and enables blood to flow through the vessels
Occurs straight away
What is percutaneous coronary intervention used for?
STEMI AND STEMI
What are the complications with PCI?
Contrast-induced nephrotoxicity
Restenosis - overtime the atherosclerotic disease starts to worsen around the stent as well - occurs quickly in some patients
Bleeding - from Antiplatelets and anticoagulants - need to monitor
In-stent thrombosis - introduction of foreign material can cause platelet aggregation
Define a drug-eluting stent
Metal framework is inserted and coated with a drug that will stop platelet aggregation - stop build up of cells and fatty tissue within that area where the stent is inserted
Often contain anti-proliferative drugs - drugs which are traditionally used as chemotherapies to stop cell division and cell build up
Define angioplasty
Balloon is used to inflate and widen the artery - used in patients that are unable to take antiplatelets and anti-coagulants due to bleeding risk
Define thrombolysis
Clot-busting medicine
Define emergency CABG
Coronary Artery Bypass Surgery
Restore blood flow around a blocked heart artery
Involves opening up the chest wall and carrying out cardiac surgeries
Define GRACE scoring
Likelihood of death within 6 months from another cardiac event
Helps determine urgency of some treatment options
Takes into account symptoms at presentation
If grace score is more than 3%…
Angiogram - type of x-ray used to examine blood vessels
PCI within 72 hours
If GRACE score is less than 3%…
Medically managed
