MYOCARDIAL ISCHAEMIA + ACS Flashcards
Myocardial ischameia
build up of atherosclerotic plaques
restricts arteries
reducing blood supply and o2 to heart
Stable angina
Predictable chest pain or pressure due physical exertion or emotional
Stable angina - Initial treatment
- Can be taken prophylactically or when symptoms arise
- Glyceryl Trinitrate dose to be taken at 5 minutes intervals
- If symptoms haven’t resolved after the second dose: medical emergency
When should emergency services be called
Emergency services should be called 5 minutes after second dose of GTN not working
Long-term Prevention
1st Line: Beta-blocker (RL-CCB if B-blocker contraindicated)
2nd Line: Beta-blocker + CCB (Amlodipine, Lacidipine, etc)
3rd Line: Long-acting nitrate, Nicorandil, Ivabradine or Ranolazine
Nicorandil - side effects
can cause Gl and mucosal ulceration
When should response to treatment be assessed?
Response to treatment should be assessed every 2–4 weeks following initiation or change of drug therapy; drug doses should be titrated to the maximum tolerated effective dose.
RL CCB and BB
never give together
Secondary prevention of cardiovascular events
Need to implement healthy life-style measures
Introduce 75mg aspirin and low dose stätin
Nitrates - MoA
Potent coronary vasodilators.
Reduce venous return and cardiac output.
Short-acting nitrates
Management of acute angina attacks
- Glyceryl trinitrate
- Isosorbide dinitrate (S/L)
long- acting Nitrates - examples
Long-term prophylaxis of angina
- MR isosorbide dinitrate
- Isosorbide mononitrate
ivabradine, nicorandil, or ranolazine.
Nicorandil
K channel activator
Risk of ulcer complications: mouth, skin, eye, GI
Do not drive until it is established and performance is not impaired.
GTN Sublingual tablets - counselling
should be discarded 8 weeks after opening bottle
MR Isosorbide dinitrate and Isosorbide mononitrate
Both taken BD.
Second dose should be taken after 8 hours.
