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16 Cards in this Set
- Front
- Back
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Module 4 - logbook 1: definition |
STEMI = ST elevation and raised troponin - total blockage NSTEMI = ST depression/nothing and raised troponin - partial blockage |
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Module 4 - logbook 1: epidemeology |
114,000 ACS admissions per year STEMI/NSTEMI divide difficult to calculate |
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Module 4 - logbook 1: risk factors - modifiable |
Smoking, hypertension, alcohol, BMI, cholesterol, diabetes and physical inactivity |
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Module 4 - logbook 1: risk factors - non modifiable |
Family history (hyperlipidemia), ethnicity (India, Pakistan and Bangladesh), age and gender |
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Module 4 - logbook 1: common presentation |
Chest pain > 20 mins at rest. May be associated with sweating, nausea, vomiting, dyspnoea, fatigue,shortness of breath and palpitations. Women - arm, back neck and jaw |
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Module 4 - logbook 1: investigations |
12 lead ECG, cardiac enzymes (troponin I ant T) peak at 12-24 hours |
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Module 4 - logbook 1: pathophysiology |
Total blockage leading to myocardial cell death |
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Module 4 - logbook 1: anatomy |
Right coronary artery - inferior - II III AVF Left anterior descending - anterior - V1-V6 AVL Left circumflex - lateral 1, AVL, V5 V6 Posterior V1-V4 depression |
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Module 4 - logbook 1: prognosis |
5-10% mortality in hospital. 5-10% have an MI within a month. Much worse with left dominance |
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Module 4 - logbook 1: management (and NICE guidelines) |
Morphone, GTN, oxygen (if O2 < 94%), ASPIRIN 300mg and CLOPIDOGREL 300mg) Immediately assess eligibility for coronary reperfusion therapy. Offer fibrinolysis (prevents blood clots from growing and becoming problematic) to people with acute STEMI presenting within 12 hours of onset of symptoms. |
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Module 4 - logbook 1: drugs - ASPIRIN |
Antiplatelet - Acetyl donor to COX rendering it inactive which reduces thromboxane A2 |
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Module 4 - logbook 1: drugs - CLOPIDOGREL |
Antiplatelet - prevents binding of ADP preventing activation of clotting factors stopping fibrinogen and platelet aggregation |
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Module 4 - logbook 1: drugs - RAMIPRIL |
Hypertension - ACE inhibitor: stops ATI converting to ATII. ATII is a potent vasdoilator. Dry cough. Monitor renal function eGFR |
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Module 4 - logbook 1: drugs - ATORVASTATIN |
Hypercholesterolemia - enzyme inhibitor HMG coA reductase, reducing quantity of mevalinic acid, a precursor of cholesterol |
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Module 4 - logbook 1: drugs - GLYCERAL TRINITRATE |
Angina - Vasodilator - dephosphrylation of mysosin light chain cuaing smooth muscle relaxation |
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Module 4 - logbook 1: drugs - BISOPROLOL |
MI prophylaxis - beta blocker - blocks beta 1 receptors reducing sympathetic stimulation |
