Zeros to Finals Flashcards
(54 cards)
what is a QRISK score?
- calculates the percentage risk that a patient will have a stroke or an MI in the next 10 years
- if they have >10% risk then start atorvastatin 20mg
what should all patients with CDK or T1DM for more than 10 years be started on?
atorvastatin 20mg
4As to remember secondary prevention of cardiovascular disease?
aspirin - plus a second antiplatelet such as clopidogrel for 12 months
atorvastatin 80mg
atenolol titrated to max tolerated dose
ACEi eg ramipril titrated to max tolerated dose
what are some side effects of statins?
- myopathy (check CK in patients with muscle pain or weakness)
- T2DM
- haemorrhagic strokes (very rare)
GS in angina?
CT coronary angiography
what is CT coronary angiography?
injecting contrast dye and taking CT images times with the heart beat to give a detailed view of the coronary arteries, highlighting any narrowing
what are the instructions for taking GTN?
spray under tongue when symptoms start, then repeat 5 mins after if required
if there is still pain after 5 mins - call 999
what is the long term symptomatic relief for angina?
5mg bisoprolol and 5mg amlodipine
what is PCI?
percutaneous coronary intervention with coronary angioplasty
- put catheter into patient’s brachial and femoral artery, feeding that up to the coronary arteries under xray guidance and injection contrast so the narrowed arteries are highlighted
- then treated with balloon dilation followed by insertion of a stent
what is CABG?
coronary artery bypass graft
- opening patient’s chest along the sternum, taking a graft vein from the patient’s leg (usually the great saphenous vein) and sewing it on to the affected coronary artery to bypass the stenosis
- complication rate higher than PCI
what does the left coronary artery become?
the circumflex and LAD
where does he RCA curve and what does it supply?
- it curves around the right side and under the heart and supplied the right atrium, right ventricle, inferior aspect of the left ventricle and posterior septal area
where does the cicrumflex artery curve and what does it supply?
- left atrium
- posterior aspect of left ventricle
where does the LAD travel and what does it supply?
- anterior aspect of the left ventricle
- anterior aspect of the septum
what do you do if someone is suspected of ACS symptoms but not ST elevation?
- perform troponin blood tests
which ECG leads are affected in left coronary artery and which heart area
I, aVL, V3-6
anterolateral
LAD leads and heart area
V1-4
anterior
circumflex leads and heart area
I, aVL, V5-6
lateral
right coronary artery and heart area
II, III, aVF
inferior
how is a diagnosis of dressler’s syndrome made?
ECG (global ST elevation + T wave inversion)
echocardiogram (pericardial effusion)
raised inflammatory markers (CRP and ESR)
what are the 4 types of MI?
type 1 - traditional MI due to acute coronary event
type 2 - ischaemia due to increased demand or reduced supply of O2 (eg secondary to severe anaemia, tachycardia or hypotension)
type 3 - sudden cardiac death or cardiac arrest suggestive or an ischaemic event
type 4 - MI associated with procedures such as PCI, coronary stenting and CABG
explain process of acute left ventricular failure
- left ventricle unable to move blood through left side of heart and out into the body
- causes backlog and increases blood in the left atrium, pulmonary veins and lungs
- fluid leaks > pulmonary oedema (lung and alveoli become full of interstitial fluid)
- interferes with normal gas exchange in the lungs > SOB, reduced O2 etc
what is the presentation of acute LVF
rapid onset breathlessness which is exacerbated by lying flat and improves on sitting up
- type 1 resp failure
what is BNP
- a hormone released from the heart ventricle when cardiac muscle is stretch beyond normal range
- if high, the heart is overloaded with blood
- BNP acts to relax the smooth muscle in blood vessels
