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28 Cards in this Set
- Front
- Back
- 3rd side (hint)
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What is the definition of unstable angina?
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Cardiac chest pain at rest
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What is stable angina?
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Cardiac chest pain that is relieved by rest (predictable exertional chest pain)
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What is crescendo angina?
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Worsening stable angina e.g. chest pain after walking 100m one day to 20m the next day
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1 in 10 my age will have early
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athersclerotic changes present
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How much of vessel needs to be occluded before symptoms are present?
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70% occlusion (100% occlusion = MI)
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What causes unstable angina?
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Atheromatous coronary plaque, inflammation, plaque rupture/erosion, intravascular thrombosis leading to partial or complete coronary occlusion. (other causes include spasm, dissection or embolism)
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Plaque rupture is more common in
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males with hypercholesteremia
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Plaque erosion is more common in
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women
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Three factors contribute to rupture:
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inflammation, thin fibrous cap, cholesterol
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Factors contributing to thrombosis:
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coagulation/fibrinolytic balance (e.g. thrombophylia/APL syndrome; smokers bad thrombolytic ability)
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Does a plaque rupture always lead to MI?
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no, most people have old collagen from previous plaque rupture
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What are the 3 underlying causes of non-thrombotic ACS?
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increased demand (thyrotoxicosis, high CO); decreased supply (anaemia, hypoxia); coronary spasm (Prinzmetal's angina, cocaine, phaeochromocytoma)
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What hormone is linked to coronary dissection?
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oestrogen (e.g. in pregnancy)
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Who would be most likely to get a silent MI?
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diabetic or elderly (would see diarrhoea and vomiting and sweating)
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STEMI would show:
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ST elevation + Q waves; high troponin; high CK
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NSTEMI would show:
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ST depression or T wave depression; raised troponin; normal CK
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Unstable angina would show:
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biphasal T wave; normal troponin and CK
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ST elevation also seen in
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pericarditis
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4 key aspects of management:
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analgesia, monitor, anti-ischaemic, complications
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Anti-ischaemic therapy include 4 classes of therapy:
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anti-platelet; anti-coagulant; nitrates; Beta-blockade (latter 2 are mainly to manage symptoms)
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Anti-platelet therapy:
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aspirin 75mg + clopidogrel 75mg (3m or 1y?) or ticagrelor? (40x expensive)
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Anti-coagulant therapy:
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unfractionated heparin* or fractionated heparin
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Give an example of a pentasaccharide
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Fondaparinux (anticoagulant that has reduced major bleeding)
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*
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PCI stands for
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Percutaneous Coronary Intervention
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CABG stands for
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Coronary Artery Bypass Graft Surgery
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When is it better to get CABG?
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if left main stem stenosis or multiple CAD
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Long-term management (4 therapies)
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antiplatelet; lipid lowering; B-blocker; ACE inhibitor (even if no HF)
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What lifestyle modification is equally as important as all therapies combined?
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smoking cessation!!!!
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