MI Flashcards
What is angina?
Chest pain caused by reduced blood flow to heart muscle
If stable - GTN can be used for rapid relief of symptoms
Difference between stable and unstable angina?
Stable - attacks have triggers, rarely last longer 10 mins, GTN relieve
Unstable: unpredictable, can continue despite rest
What wouldn’t be consistent with angina?
Crushing sever central chest pain
Clammy/ feel sick - over activation sympathetic nervous system
What is GTN?
Nitrate - widen blood vessel to increase blood flow
Pain angina usually last <3 min if not relieved GTN
Consequence GTN
Headache
What is acute coronary syndrome?
Modern diagnosis - include angina and MI
Can’t differentiate until tested in hospital setting
Medical emergency management
MONA Morphine - coronary artery relaxation Oxygen Nitrare - relax coronary blood vessel Aspirin - 300mg - reduce platelet activation
What is MI?
Narrowing of coronary arteries due to plaque - become dislodged and occlude vessel
Unresponsive to angina medication
Symtoms MI
Nausea, vomit, sweating, palpitation, breathlessness, fainting, pain left arm (nerve branch from heart and those left arm sent same place - hard to differentiate)
Tx of MI
Anticoagulation
Angiography - stenting
Secondary prevention - DAPT year
Cardiac rehab
What is NSTEMI
No change in ECG - blood supply may only be partially blocked
RF NSTEMI
Smoker, physically inactive, high BP, diabetes
Diagnosis MI - STEMI/NSTEMI
Need 2 out of 3: chest pain, ECG feature, positive troponin
Blood test - serum troponin (need wait for levels to rise)
ECG
Why elevated JVP heart failure?
No valves between internal jugular and right heart -if damming of blood RHS JVP may rise
Difference between RHS and LHS heart failure?
RHS - peripheral oedema, raised JVP
LHS: (oxygenated blood): fatigue, pulmonary oedema
What could you use other than troponin and disadv?
Creatine kinase - related to muscle break down therefore can be inaccurate
What is troponin?
Molecule related to contractibility of heart - cardiac specific
Take 6-12 hour to show - 3 hours if sensitive
Management of STEMI
- Thrombolysis - kinases
2. PCI - percutaneous coronary intervention = stent
Why is PCI not always option?
Need qualified cardiologist and access to cardiology unit
Use of angiogram?
Aid placement of stent - use iodine
Use treadmill test in unstable angina?
Look ST depression - if have unstable angina and ST depression w/ exercise may indicate PI
Tx pt in dental setting 8 months later
NSTEMI - will be on clopidogrel
If dual therapy - haematology advice
First 6 month -tx hospital
Medication used to reduce death on discharge?
A- aspirin A- ACE inhib B- beta-blocker C- clopidogrel (STEMI 1 month, NSTEMI - 1 year) S- statin
