Myocardial Ischemia Flashcards
What is meant by myocardial ischaemia
Build up of atherosclerotic plaque which restricts arteries reducing the blood supply of blood and oxygen to the heart
What is meant by stable angina
Predictable chest pain or pressure due to physical excretion or emotional
What is the initial treatment of stable angina
Can be taken prophylactically or when symptoms arise
Glyceryl tritiinate dose can be taken at 5 minute intervals
- if symptoms hasn’t resolved after the second dose: medical emergency
What is the long term prevention of stable angina
1st line: beta blocker OR CCB if b-blocker is contraindicated)
2nd line: beta blocker and CCB ( amlodipine, lacidipine etc) never RL-CCB
3rd line: long acting nitrate, Nicorandil, ivabradine or ranolazine
-nicorandil: can cause GI and mucosal ulceration
Need to implement healthy life style measures
Introduce 75mg aspirin and low dose statin
What are nitrates
GTN sublingual tablets: should be discarded after 8 weeks after opening bottle
Tolerance:
Patients should have a nitrate free period to prevent tolerance
Second dose should be given 8 hours after first dose instead of 12
In transdermal use: patches Should be left off for 8-12 hours per day
Side effects:
Dizziness, flushing and headaches
Should be prescribed in caution in elderly due to risk of falls
What are the major risk factors of acute coronary syndrome
Family history
Hypertension
Hypercholesterolaemia
Diabetes
Smoking
All syndromes are quite similar in terms of initial and secondary treatment
What is the initial treatment of acute coronary syndrome
For confirmed ACS:
Loading dose of aspirin is 300mg
Pain relief: GTN +/- morphine
Oxygen if needed
From test results determine if NSTEMI, unstable angina or STEMI
-PARTIAL blockage of artery- myocardial necrosis in only NSTEMI
-COMPLETE blockage of artery causing myocardial necrosis is STEMI
What are the different types of ACS
From test results determine if NSTEMI unstable angina or STEMI:
NSTEMI and unstable angina: partial blockage of the artery
STEMI complete blockage of the artery
NSTEMI : ST zones of the ECG is not elevated
STEMI: ST zones of ECG is elevated
STEMI require percutaneous coronary intervention (PCI) within 2 hours (unblocking the blocked artery )
- patients should be given heparin if PCI is done through radial access
Preferred secondary anti platelets would be prasugrel in long term management
What does NSTEMI stand for
Non ST elevated myocardial infarction
What is secondary prevention of ACS
Patient will walk out with these 5 medications
Dual anti platelet therapy
Lifelong is aspirin
12 months: clopidogrel, prasugrel or ticagrelor
Ace inhibitor:
ARB if ace is contraindicated
Beta blockers:
Might be discontinued after 12 months in patients without reduced LVEF
Statins:
High strength (atorvastatin 80mg)
Patients with NSTEMI might consider PCI to prevent future MI
Assess the risk of heart failure
