Professional Documents
Culture Documents
Week 10
Definition:
It is a set of signs and symptoms – due to decreased blood flow in the arteries
Could lead to HF, AF
Causes:
Usually a spontaneous rupture or fissuring of an atheromatous plaque in the coronary arterial wall
Thrombosis and obstruction in coronary artery (stops blood flow through the coronary artery)
Classification:
Classified depending on death in cardiac muscle (also called myocardial infarction (MI))
Risk Factors
Modifiable Non-modifiable
Smoking Age
Diabetes esp. Type 2 Male
Hypertension Family History
Dyslipidaemia – increased cholesterol History of angina
Obesity
Psychological factors
Lack of exercise
Diet low in fruit + vegetables and rich
in saturated and trans fats
Diagnosis:
1. Patient History
Age
Past Medical History (hypertension, angina, etc.)
Medication history
2. Symptoms
Pain that is:
o Persistent (even when at rest), lasting > 15 mins
o Radiating to jaw, back, shoulder, neck, arm
o Crushing (not always)
o Increasing in intensity
Sudden onset of pain
Breathlessness, hypotension, dizziness, syncope, tachycardia + sweat/bradycardia +
N&V (depending on nerve activated i.e. sympathetic or vagal)
Fever - Inflammation
Leucocytosis – increased inflammatory markers
4th heart sound – forceful filling of left ventricle
3. 12 lead ECG
STEMI = ST-segment persistently elevated or new left bundle branch block
NSTEMI/UA = normal ECG or depressed ST-segment or T wave inversion
4. Troponin Levels - only raised in MI
STEMI/NSTEMI = Raised troponin lvls
UA = normal troponin lvls
Management
2 Steps:
Before Discharge:
Echo scan – to check if MI has caused HF
o Assess LV function
o Assess EF – if < 40% = consider aldosterone antagonist (eplerenone)
1. Beta Blocker (lifelong) – C/I in asthma, NOT COPD. Decreases workload on heart.
Bisoprolol 10mg OD
Metoprolol 10mg BD
4. Statins (lifelong)
Atorvastatin 80mg – can decrease to 20mg OD if renal function is low
6. GTN Spray – 400mcg/puff. 1 puffs to relieve chest pain. Repeat twice in 5 minute intervals.
If no relief call ambulance.
7. If history of dyspepsia or over 75 consider PPI
Monitoring:
Non-Pharmacological:
Diet
Exercise
Smoking cessation (champix, NRT)
Cardiac rehabilitation and education
Weight loss
Avoid OTC NSAIDs (ibuprofen, aspirin, etc.)
Note: Consider implantable defibrillator as part of 2° prevention in patients with impaired left
ventricular function and ventricular arrhythmias (can reduce mortality).
Which of the following is the first choice (NICE) P2Y12 receptor antagonist for use in combination with aspirin?
A. Clopidogrel 75mg daily
B. Eplerenone 50mg daily
C. Prasugrel 10mg daily
D. Spironolactone 50mg daily
E. Ticagrelor 90mg BD
Ans: E
Mr. A comes into your pharmacy and describes the sudden onset of chest pain. Differential diagnosis?
Angina
Unstable angina
NSTEMI
STEMI
Chest/respiratory infection
Tumour in lungs/chest area
MSK injury - pulled muscle
PE
Indigestion
Reflux (oesophageal disease often mistaken for MI by patient)
Recent breakup
Worst case scenario is MI - myocardial infarction
999 for further investigation + treatment
Which of the following is not recommended for secondary prevention?
A. Aspirin 75mg daily
B. Atorvastatin 80mg daily
C. Bisoprolol 10mg daily
D. Dabigatran 110mg BD
E. Ramipril 10mg daily
Ans: D