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22 Cards in this Set
- Front
- Back
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Name the 3 types of Acute Coronary Syndrome?
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1. STEMI
2. NSTEMI 3. Unstable Angina |
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What is the difference between NSTEMI and unstable angina?
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In NSTEMI there is occluding thrombus which results in myocardial necrosis and an increase in troponins or CK- MB.
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When does MI occur?
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When cardiac myocytes die due to myocardial ischaemia
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How id an MI diagnosed?
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Clinical history
ECG Raised biochemical markers- Troponin I and T, CK-MB |
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What is the common mechanism to all ACS?
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Rupture/ Erosion of fibrous cap of a coronary artery plaque.
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What does this cause?
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1. Platelet aggregation and adhesion
2. Localised thrombosis 3. Vasoconstriction 4. Distal thombus embolization (Steps 2 and 3 are due to platelet release of seretonin and thromboxane A2) |
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Name 3 features of clinical presentation of an ACS?
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1. New onset chest pain
2. Chest pain at rest 3. Deterioration of pre- existing angina |
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Name 3 atypical features of and ACS?
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1. Indigestion
2. Pleuritic chest pain 3. Dyspnoea |
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Name 3 alternative diagnoses
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1. Aortic dissection
2. Pulmonary embolism 3. Peptic ulceration |
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When is transient ST elevation seen?
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With coronary vasospasm or Prinzmetal's angina
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What is Prinzmetal's Angina?!
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Angina at rest which occurs in cycles. It is due to vasospasm, a narrowing of the coronary arteries caused by contraction of the smooth muscle tissue in the vessel walls rather than directly by atherosclerosis.
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Name 5 anit thrombin agents used in ACS treatment
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1. Heparin
2. Bivalirudin 3. Fondaparinux 4. Rivaroxaban 5. LMWH = enoxaparin |
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Name 4 anti platelet agents used in ACS treatment
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1. Aspirin
2. Clopidogrel (Avoid if CABG planned) 3. Ticagrelor 4. Prasugrel |
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Name 3 Glycoprotein IIB/IIA inhibitors
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1. Eptifibatide
2. Abciximab 3. Tirofiban |
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When are glycoprotein inhibitors used?
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Used during PCI/ without coronary intervention
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Name 2 types of analgesia used
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Morphine
Diamorphine |
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What is always prescribed with analgesia?
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Anti emetics e.g metoclopramide
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What is used to decrease myocardial energy consumption?
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Atenolol
Metoprolol |
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When should these agents be avoided?
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Asthma
Heart Failure Hypotension Bradyarrythmias |
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What agents are used in plaque stabilization/ Ventricular remodelling?
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ACE INHIBITORS
- Ramipril - Lisinoprill (Change to ARA if dry cough, monitor renal function) HMG-CoA REDUCTASE INHIBITORS - Simvastatin - Pravastatin - Atorvastatin |
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What is used to produce coronary vasodilation?
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Glyceryl Trinitrate
(maintain systolic BP above 90mmHg) |
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What is also essential in the treatment of ACS?
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Myocardial oxygenation!!
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