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cardiology > Angina, IHD > Flashcards

Angina, IHD Flashcards

1
Q

What is ischemic heart disease

A

heart problems caused by narrowed vessels

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2
Q

what can cause IHD

A
  • increased myocardial workload
  • coronary artery occlusion
  • insufficient oxygen rich blood supply
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3
Q

non modifiable risk factors for IHD

A

Family history
age
ethnicity s asian

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4
Q

modifiable risk factors

A

smoking
poor nutrition
sedentary lifestyle
alcohol
stress
HTN
obesity
DM

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5
Q

What is angina

A
  • constricting discomfort in front of chest, neck, shoulders, jaws or arms
    -precipitated by physical exertion
  • relieved by rest
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6
Q

What is stable angina

A

central crushing chest pain but
it is relevied by rest of GTN spray

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7
Q

what is unstable angina

A

when the symptoms come on randomly whilst at rest
Cardiac chest pain with crescendo pattern

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8
Q

what is unstable angina an example of

A

acute coronary syndrome

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9
Q

GS investigation for angina

A

CT coronary angiography

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10
Q

what does ct coronary angiography involve

A

injecting contrast and taking CT images timed with the heart beat to give a detailed view of coronary arteries

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11
Q

Other investigations of IHD

A

ECG- usually normal
lipid profile
FBC
hba1c- to exclude DM

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12
Q

Principles of angina manegement

A

R- Refer to cardio
A- advise about diagnosis
M-medical management
P- procedural or surgical interventions

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13
Q

Immediate and long term medical management for angins

A

immediate- GTN spray
long term- beta blocker- bisoprosol or calcium channel blocker ( amlodipine )

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14
Q

2nd line management for angina

A

CCB or beta blockers

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15
Q

What does the gtn spray do

A

-used as required
-causes vasodilation and helps relieve symptoms

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16
Q

Secondary prevention of stable angina

A

A- aspirin
A-atoravastin
A- ACE inhibitor
A- already on a beta blocker

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17
Q

what is acute coronary syndrome

A

thrombus from an atherosclerotic plaque blocking a coronary artery

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18
Q

what does ACS cause

A
  • unstable angina
  • STEMI
    -NSTEMI
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19
Q

RCA SUPPLIES

A

RA
RV
Inferior aspect of LV
posterios septal area

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20
Q

What does STEMI mean

A

ST- elevation myocardial infarctio

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21
Q

What does NSTEMI mean

A

Non - st elevation myocardial infarcation

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22
Q

Presentation of ACS

A
  • CENTRAL CONSTRICTING CHEST PAIN RADIATING TO JAW/ARMS
  • sweating
  • shortness of breath
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23
Q

Making a diagnosis would involve ?

A

ECG

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24
Q

If there is st elevation or new left bundle branch block what is the diagnosis

A

STEMI

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25
Q

What would an ecg show for NSTEMI

A
  • ST segment depression
  • Deep T wave inversion
  • Pathological Q waves
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26
Q

If there is no ST elevation after performing an ECG what would you do and what would the diagnoses be

A
  • troponin blood tests
  • raised troponin and ecg changes= NSTEMI
  • normal troponin and no ecg changes then = unstable angina
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27
Q

STEMI management

A

M- morphine
O- oxygen therapy is sats below 94%
N- nitrates
A- aspirin 300mg

Second anti platelet drug should be given such as clopidogrel

PPI within 90 mins
If not then thrombolysis

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28
Q

management for NSTEMI

A

MONA
USE grace score to predict 6 month mortality + risk of further cardio events
- anything other than lowest risk should also be given prasugrel or ticagrelor unless they have a high risk of bleeding where PO clopidogrel is better
- fondaparinux

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29
Q

Secondary prevention of ACS

A

ACEi
Clopidogrel
Aspirin
Beta blocker

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30
Q

Post MI complications

A

Death
Rupture of heart septum/ papillary muscles
Edema
Arrythmias
Aneurysm
Dresslers syndrome

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31
Q

Diagnosis for unstable angina involves

A

History
Ecg
Troponin

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32
Q

Myocardial infarction normally occurs when and how does it present

A

Unremitting Chest pain
Usually severe but may be mild or absent occurs at rest
Associated with sweating , breathlessness, nausea
One third occur in bed at night

33
Q

Initial management of MI from being at home

A

Get into hospital quickly
Paramedics - If ST elevation then contact primary pci for transfer
Take aspirin 300mg immediately
Pain relief

34
Q

Hospital management of MI

A

Make diagnosis
Bed rest
Oxygen therapy if hypoxic
Pain relief
Consider beta blocker
Consider other anti angina medication

35
Q

Cause of acs

A

Rupture of an atherosclerotic plaque and consequent arterial thrombus

36
Q

What is troponin

A

• Protein complex regulates actin:myosin contraction
• Highly sensitive marker for cardiac muscle injury

37
Q

Role of thrombin

A

Activates platelets
Final factor in coagulation cascade as it cleaves fibrin to fibrinogen

38
Q

3 point definition of angina

A

1- central crushing pain
2- brought on with exertion
3- relieved with 5 mins rest or GTN spray

39
Q

Most common options for p2y12 inhibitors

A

Clopidogrel
Prasugrel
Ticagrelor

40
Q

What do anti coagulants do

A

Inhibit fibrin formation , platelet activation

41
Q

what is vasculitis

A

AN inflammatory and variably necrotic process centred on blood vessels that may involve arteries , veins or capillaries

42
Q

immune background of vasculitis

A

Deposition of immune complexes

  • Direct attack on vessels by antibodies
  • Cell mediated immunity
  • Viral infection
  • Serum sickness = mode
43
Q

what is dresslers syndrome

A

post myocardial infarction syndrome
localised immune response and causes pericarditis

44
Q

what is the presentation of dresslers syndroem

A

pleuritic chest pain
low grade fever
pericardial rub

45
Q

how to diagnose dresslers syndroem

A

ECG- ST elevation and T wave inversion
Echocardiogram
raised inflammatory markers

46
Q

what is left sisded cardiac failure

A

PULMONARY congestion and then overload of right side

47
Q

IHD predisposing factord

A

Age
Cigarette smoking
Family history
Diabetes mellitus
Hyperlipidemia
Hypertension
Kidney disease
Obesity
Physical inactivity
Stress
Male

48
Q

exacerbating factors related to supply of angina

A

Anemia
Hypoxemia
Polycythemia
Hypothermia
Hypovolaemia
Hypervolaemia

49
Q

exacerbating factors related to supply of angina

A

Anemia
Hypoxemia
Polycythemia
Hypothermia
Hypovolaemia
Hypervolaemia

50
Q

exacerbating factors of demand to do with angina

A

Hypertension
Tachyarrhythmia
Valvular heart disease

Hyperthyroidism
Hypertrophic cardiomyopathy

51
Q

environmental factors of angina

A

exercise
cold weather
heavy meals
emotional stress

52
Q

when does myocardial ischemia occur ?

A

when there is an imbalance between the heart’s oxygen demand and supply, usually from an increase in demand and a limited supply

53
Q

what can cause a limited supply

A
  1. Impairment of blood flow by proximal arterial stenosis
  2. Increased distal resistance eg left ventricular hypertrophy
  3. Reduced oxygen-carrying capacity of blood eg anemia
54
Q

what occurs in prinzmetals angina

A

vessels become narrow with coronary spasm

55
Q

history of IHD

A

Personal details (demographics, identifiers)
Presenting complaint
History of PC + risk factors
Past medical history
Drug history, allergies
Family history
Social history
Systematic enquiry

56
Q

CARDIAC symptoms of IHD

A

Chest pain
breathlessness
- no fluid retention
-palpitation
-syncope or pre-syncope

57
Q

TREATMENT for ischemic heart disease

A
  • reassure
    -lifestyle; smoking, weight, exercise, diet
    -advice for emergency
  • medication
  • revascularisation
58
Q

ST depression is ?

A

ischemia

59
Q

gold standard test for IHD

A

PERFUSION MRI

60
Q

2ND line management medicine for angina

A

calcium channel blocker

61
Q

beta blocker effect on the heart for angina

A

reduce heart rate
reduce contractility
reduce workload
reduce oxygen demand

62
Q

side effects of b blockers

A

tiredness
bradycardia
erectile dysfunction
cold hands and feet

63
Q

b blockers contraindications

A

SEVERE ASTHMA- ABSOLUTE ASTHMA

64
Q

what do nitrates do for angins

A

expands venous capacity
reduces preload
dilates coronary arteries

65
Q

SE of nitrates

A

HEADACHE

66
Q

what do calcium channel blockers do for angian

A

DILATE arteries
decreases afterload
reduces oxygen demand

67
Q

what two types of meds cause gastric ulcers

A

Aspirin
NSAID

68
Q

what does ace inhibitor do for angina

A

LESS ANG2 produced
less vasocontriction

69
Q

What is CABG

A

coronary artery bypass graft

70
Q

Main difference between stable unstable and prinzmetal angina

A

Stable and unstable show st segment depression
Prinzmetal shows st elevation

71
Q

diagnostic features of acs

A

Unstable angina - Cardiac chest pain + abnormal/normal ECG + normal troponin
NSTEMI - Cardiac chest pain + abnormal/normal ECG (but not ST-elevation) + raised troponin
STEMI - Cardiac chest pain + Persistent ST-elevation/new LBBB (note that there is no need for a troponin in this case)

72
Q

diagnosis of nstemi involves

A

Cardiac chest pain
Newly abnormal ECG which is NOT ST-elevation
Raised troponin (with no other reasonable explanation)

73
Q

diagnosis of stemi

A

ST segment elevation >2mm in adjacent chest leads
ST segment elevation >1mm in adjacent limb leads
New left bundle branch block (LBBB) with chest pain or suspicion of MI

74
Q

non acs reasons as to why troponin may be raised

A

Myocardial infarction
Pericarditis
Myocarditis
Arrythmias
Defibrillation
Acute heart failure
Pulmonary embolus
Type A aortic dissection
Chronic kidney disease
Prolonged strenuous exercise
Sepsis

75
Q

Changes in v1-v4 would suggest

A

occlusion in ANTERIOR LAD

76
Q

Changes in lead 2 ,3 and avf would suggest

A

inferior occlusion of right coronary

77
Q

changes in lead 1 v5-v6 would suggest

A

lateral circumflex occlusion

78
Q

right coronary leads are

A

lead 2
lead 3
avf

79
Q

what would a nstemi show on ech

A

st segment depression - almost upside down

cardiology (16 decks)

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