Symposium 1 - Ischaemic heart disease and acute coronary syndrome Flashcards
Complete the diagram of coronary vessels
What is ACS characterised by?
ACS is characterised by the development of a thrombosis at the site of acute disruption of an atherosclerotic plaque
What are the 2 ways an atherosclerotic plaque can disrupt?
Disruption may be superficial erosion of the endothelium over a fibrous cap or acute deep plaque rupture
Complete the diagram on the stages of atherosclerosis
Following plaque disruption, thrombus results from what?
- Adherence, activation and aggregation of platelets
- Thrombin and fibrin production via the coagulation cascade (and thrombin release from platelets)
- Release of vasoactive molecules from platelets causing vasoconstriction
Complete the diagram of an atherosclerotic plaque
Complete the diagram on changes which occur on an ECG during a STEMI?
Label each section of the 12 lead ECG with either -
- Lateral
- Inferior
- Anterior
- Anterior-septal
What does this ECG show?
Anterolateral ST elevation myocardial infarction
What does this ECG show?
Inferior ST elevation myocardial infarction
What does this ECG show?
Lateral ST elevation myocardial infarction
How does a heart attack happen?
- Heart disease develops over time as fatty deposits narrow coronary arteries, restricting blood flow to the heart
- The coronary artery occludes usually due to a clot resulting from ruptured atherosclerotic plaque
- Blood flow is restricted and a heart attack begins
- If blockage continues, parts of the heart muscle start to die
- Heart may stop beating, leading to cardiac arrest
What stops a heart attack?
- Quick action and medical treatment restores blood flow and saves heart muscle
- ‘Time is muscle’
- Dead heart muscle cannot be restored
- The more heart muscle that is saved, the better the chance of survival and the better the outcome
How is a STEMI treated?
Antiplatelet agents (aspirin + clopidogrel)
AND
‘Primary’ angioplasty (balloons, stents): artery is mechanically reopened, restoring blood flow (gold-standard treatment)
“Clot-busting” drug (thrombolysis): pharmacologically break up clots, restoring blood flow (only used if primary angioplasty is not available)
What procedure is this?
Balloon Angioplasty & Stent
What are heart attack warning symptoms?
Chest discomfort—pressure, squeezing, fullness or pain in center of chest
Chest pain radiating to arm(s), back, neck or jaw
Shortness of breath
Breaking out in a cold sweat
Nausea
What is the onset of a heart attack often like?
Often begins with vague symptoms that slowly intensify
Pain or discomfort can be relatively mild
Symptoms may come and go
What are the symptoms of heart attacks in women?
May feel pain or discomfort in chest
Other symptoms include:
- Shortness of breath
- Nausea/vomiting
- Back or jaw pain
Do men or women delay seeking help more?
Women
Which patients have atypical heart attack presentations?
Women
Elderly
- Confusion
- Collapse ? Cause
- In context of pneumonia etc.
Diabetics
- ‘silent’
- Diabetic ketoacidosis
- Breathlessness
What is the biggest cause of not receiving rapid care in an MI?
Patient delay
What are the theraputic goals in a STEMI?
Restore epicardial vessel patency
Limit myocardial necrosis
Control symptoms
What are the 3 elements of medical management in a STEMI?
Anti-platelelet therapy
Anti-ischaemic therapy
Secondary prevention
What does secondary prevention for an MI include?
Antiplatelet therapy
- aspirin
- clopidogrel /prasugrel /ticagrelor
Statin
Beta blockers
ACE inhibitors
Smoking cessation
Lifestyle modification
What does the catheter lab team include?
Consultant cardiologist
1 middle grade doctor (SpR/fellow)
1 radiographer
1 cardiac physiologist
1 or 2 scrub nurses
What is monitiored in a catheter lab?
Blood pressure
Oxygen saturations
ECG – ST segments
Arrhythmias
- Bradycardia
- Tachycardias
- Atrial fibrillation
- Ventricular tachycardia
- Ventricular fibrillation
What is cardiac rehabilitation?
“The coordinated sum of activities* required to influence favorably the underlying cause of cardiovascular disease as well as to provide the best possible physical, mental and social conditions, so that patients may by their own efforts, preserve or resume optimal functioning in their community and through improved health behavior, slow or reverse progression of disease’’.
What are the patient goals in cardiac rehabilitation?
- Recovery
- Secondary Prevention
- Adoption & Maintenance of Healthy Lifestyle
- Preservation of Mobility and self-Sufficiency
- Return to Work
- Cost-Effectiveness for the Health Service
What are the components of cardiac rehabilitation?
- Exercise
- Education
- Psychological support
- Lifestyle and Risk factor modification
- Medical Risk Management
What is the delivery / MDT team for cardiac rehabilitation?
- Multidisciplinary team approach
- Cardiac rehabilitation specialist nurses
- Physiotherapists
- Dietician
- Administrator
- Clinical lead
- Psychologist / Psychology practitioners
- Pharmacist
- Occupational therapist
