Myocardial Ischaemia Flashcards
what is myocardial ischaemia?
build up of atherosclerotic plaques which restrict arteries + reduces supply of blood + o2 to heart
what is stable angina
- predictable chest pain or pressure due to physical or emotional
- stops within few mins of resting
given prophylatically or when symptoms arise
initial tx of stable angina
-GTN doses at 5 minute intervals
-if by 2nd dose not working = medical emergency
long-term prevention of stable angina
1) Beta blocker (RL-CCB Iif bblocker CI)
2) B-blocker + CCB (amlodipine, lacidipine etc)
3) long acting nitrate, nicorandil, ivabradine or ranolazine
s/e of nicorandil
can cause GI and muscosal ulceration
other long-term prevention of angina
-implement healthy life-style changes
-introduce 75mg aspirin + low dose STATIN
when do you discard GTN sublingual tablets
8 weeks after opening
how to avoid nitrate tolerance?
-nitrate free period
-2nd dose given 8hr after 1st dose not 12hr
-transdermal patch - leave off 8-12hr per day
s/e of nitrates
- dizziness
- flushing
- headaches
- caution in elderly = falls
major risks in acute coronary syndrome
- family history
- hypertension
- hypercholesterolaemia
- diabetes
- smoking
what happens in real-life scenario of ACS
- medical team arrives and gives initial tx
- pt taken to hospital to test ECG + biomarkers
- tests determine if symptoms = unstable angina/NSTEMI/STEMI
- if STEMI then PCI needed within 2HR
- all three syndromes = secondary prevention started
tx if confirmed ACS
1) loading dose of asipirin 300mg
2) pain relief: GTN +/- IV morphine
3) oxygen PRN
what does partial blockage of artery cause?
myocardial necrosis in only NSTEMI
What doses complete blockage of artery cause?
myocardial necrosis in STEMI
What is NSTEMI and unstable angina
partial blockage of artery
what is STEMI
Complete blockage of artery
Is ST zone of ECG elevated in NSTEMI?
No
Is ST zone of ECG elevated in STEMI?
yes
What does STEMI require within 2 hours?
percutaneous coronary intervention (PCI)
If PCI is done via radical acess what should pt be given
heparin
what is the preferred secondary anti-platelet in long-term tx after PCI
prasugrel
what is the secondary prevention/long-term management of ACS?
-dual antiplatelet therapy - asiprin (lifelong) + 12MT = clopidogrel/prasugrel or ticagrelor
-ACEI (ARB is CI)
-Beta-blocker (may discontinue after 12 MT in pt w/o reduced LVEF)
-Statin (atorvastatin 80mg)
assess risk of heart failure
in pt with NSTEMI what is considered to prevent future MI
PCI
Nicorandil how many days after opening to discard pack
30 days
