MI

Question 1

What is angina?

Answer 1

Chest pain caused by reduced blood flow to heart muscle

If stable - GTN can be used for rapid relief of symptoms

Question 2

Difference between stable and unstable angina?

Answer 2

Stable - attacks have triggers, rarely last longer 10 mins, GTN relieve
Unstable: unpredictable, can continue despite rest

Question 3

What wouldn’t be consistent with angina?

Answer 3

Crushing sever central chest pain

Clammy/ feel sick - over activation sympathetic nervous system

Question 4

What is GTN?

Answer 4

Nitrate - widen blood vessel to increase blood flow

Pain angina usually last <3 min if not relieved GTN

Question 5

Consequence GTN

Answer 5

Headache

Question 6

What is acute coronary syndrome?

Answer 6

Modern diagnosis - include angina and MI

Can’t differentiate until tested in hospital setting

Question 7

Medical emergency management

Answer 7

MONA
Morphine - coronary artery relaxation
Oxygen 
Nitrare - relax coronary blood vessel 
Aspirin - 300mg - reduce platelet activation

Question 8

What is MI?

Answer 8

Narrowing of coronary arteries due to plaque - become dislodged and occlude vessel
Unresponsive to angina medication

Question 9

Symtoms MI

Answer 9

Nausea, vomit, sweating, palpitation, breathlessness, fainting, pain left arm (nerve branch from heart and those left arm sent same place - hard to differentiate)

Question 10

Tx of MI

Answer 10

Anticoagulation
Angiography - stenting
Secondary prevention - DAPT year
Cardiac rehab

Question 11

What is NSTEMI

Answer 11

No change in ECG - blood supply may only be partially blocked

Question 12

RF NSTEMI

Answer 12

Smoker, physically inactive, high BP, diabetes

Question 13

Diagnosis MI - STEMI/NSTEMI

Answer 13

Need 2 out of 3: chest pain, ECG feature, positive troponin
Blood test - serum troponin (need wait for levels to rise)
ECG

Question 14

Why elevated JVP heart failure?

Answer 14

No valves between internal jugular and right heart -if damming of blood RHS JVP may rise

Question 15

Difference between RHS and LHS heart failure?

Answer 15

RHS - peripheral oedema, raised JVP

LHS: (oxygenated blood): fatigue, pulmonary oedema

Question 16

What could you use other than troponin and disadv?

Answer 16

Creatine kinase - related to muscle break down therefore can be inaccurate

Question 17

What is troponin?

Answer 17

Molecule related to contractibility of heart - cardiac specific
Take 6-12 hour to show - 3 hours if sensitive

Question 18

Management of STEMI

Answer 18

1. Thrombolysis - kinases

2. PCI - percutaneous coronary intervention = stent

Question 19

Why is PCI not always option?

Answer 19

Need qualified cardiologist and access to cardiology unit

Question 20

Use of angiogram?

Answer 20

Aid placement of stent - use iodine

Question 21

Use treadmill test in unstable angina?

Answer 21

Look ST depression - if have unstable angina and ST depression w/ exercise may indicate PI

Question 22

Tx pt in dental setting 8 months later

Answer 22

NSTEMI - will be on clopidogrel
If dual therapy - haematology advice
First 6 month -tx hospital

Question 23

Medication used to reduce death on discharge?

Answer 23

A- aspirin
A- ACE inhib
B- beta-blocker
C- clopidogrel (STEMI 1 month, NSTEMI - 1 year)
S- statin