Myocardical Ischaemia Flashcards
what is stable angina?
predictable chest pain in relation to an activity e.g., physical exercise
whats the initial management of stable angina?
GTN at 5 minute intervals
if symptoms not resovled by the 3rd dose call 999
what do you need to know about nicorandil?
it can cause GI ulcerations
whats the long term prevention of stable angina? (1st, 2nd and 3rd line options)
1st = beta blocker (rate limiting CCB if beta blocker contraindicated)
2nd = beta blocker + CCB (amlodpine)
3rd = long acting nitrate - nicorandil, ivabradine, ranolazine
along side intial and long term management of stable angina - what other measures should be introduced?
healthy lifestyle
75mg aspirin
low dose statin
how long can you keep GTN subingual tablets once opened?
8 weeks after opening
when should you counsel patients to take thier nitrates?
need a nitrate free period to prevent tolerance
second dose of nitrate should be taken 8 hours after the 1st dose
transdermal dose - patches should be left off for 8 - 12 hours a day
how long should GTN patches be left off each day?
8 - 12 hours
what are the main SE of nitrates?
dizziness, flushing, headaches
risk of falls in elderly
what is needed within 2 hours for a STEMI which isn’t for a NSTEMI/unstable angina?
percutaneous coronary intervention
PCI
whats the initial management for all ACS?
- loading dose aspirin 300mg
- pain relief - GTN +/- morphine
- O2 if needed
what is the main difference between NSTEMI, STEMI and unstable angina?
STEMI = complete blockage of artery and ST elevation
NSTEMI/unstable angina = partial blockage little/no myocardial necrosis
what anticoagulant is given to patients undergoing PCI?
heparin
whats the preferred long term secondary antiplatelet in patients who have undergone PCI?
prasugrel
whats secondary prevention for all ACS?
life long asprin
12 months: clopidogrel, prasugrel (if PCI) or ticagrelor
