CVS Session 10- Chest Pain And IHD Flashcards

1
Q

What are the three respiratory causes of chest pain?

A

Pneumothorax
Pneumonia
Pulmonary embolism

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2
Q

What are the 2 GI causes of chest pain?

A

Acid reflux

Gallbladder- cholecystitis

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3
Q

What are the 3 musculoskeletal causes of chest pain?

A

Fracture/trauma to ribs
Muscle pain
Bone metastases

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4
Q

When does flow occur?

A

During diastole

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5
Q

When does myocardial Ischaemia occur?

A

When the supply cannot meet the oxygen demand of the myocardium

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6
Q

What is the most common cause of ischaemic heart disease?

A

Atheromatous coronary artery disease

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7
Q

What are the 3 non-modifiable risk factors of coronary artery disease?

A

Family history
Increasing age
Gender

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8
Q

What are the 4 main modifiable risk factors of coronary artery disease?

A

Diabetes
Hypertension
Hyperlipidaemia
Smoking

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9
Q

Describe an Atheromatous plaque.

A

It has a necrotic centre with a fibrous cap.

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10
Q

What is the result of an unstable plaque rupture?

A

It causes blood to be exposed, platelets to aggregate and fibrin to form a clot. This forms a thrombus which reduces the lumen size, decreases blood flow and causes Ischaemia.

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11
Q

What is the difference between stable and unstable angina?

A

Stable angina resolves after a few minutes with rest, where as unstable angina doesn’t and occurs during rest.

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12
Q

What 3 factors trigger stable angina?

A

Exercise
Cold
Meals

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13
Q

Is there myocyte injury or necrosis in stable angina?

A

No

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14
Q

What two factors relieve stable angina?

A

Nitrate spray

Rest

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15
Q

What can be seen in the ECG of someone with stable angina:

a. At rest
b. Upon exertion

A

a. Normal ECG trace

b. ST depression

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16
Q

What are the two aims of treatment of stable angina?

A

Increase blood flow

Reduce myocardial oxygen demand

17
Q

What are 3 treatments of stable angina that lower the myocardial oxygen demand? How do they do this?

A

Beta blockers- reduce the HR and contractility
Calcium channel blockers- cause peripheral vasodilatation and therefore reduce the after load
Nitrates- cause venodilation and therefore reduce the preload

18
Q

What are the 3 treatments of stable angina that increase blood flow? How do they do this?

A

Aspirin- Decrease platelet aggregation and therefore thrombus formation
Statins- reduced LDL cholesterol and therefore prevent further atherosclerosis
Revascularisation

19
Q

What is acute coronary syndrome the result of?

A

Coronary artery occlusion

20
Q

What is a STEMI?

A

A myocardial infarction with ST elevation that is the result of a complete occlusion of the coronary artery and consequent Ischaemia and myocardial necrosis.

21
Q

What is NSTEMI?

A

It is a myocardial infarction without ST elevation. It is a partial occlusion of a coronary artery that doesn’t result in myocardial necrosis.

22
Q

What is unstable angina?

A

It is a progression of stable angina because of atheroma progression, that occurs during rest.

23
Q

What are the similarities between NSTEMI and unstable angina? (2)

A

Partial occlusion of coronary artery by thrombus

ST depression

24
Q

What distinguishes between NSTEMI and unstable angina?

A

The prescence of cardiac biomarkers in the blood.

NSTEMI has troponin present, unstable angina doesn’t.

25
Q

What is an exercise stress test and when is it used?

A

It is used when stable angina is an uncertain diagnosis following a history being taken.
The patient is hooked up to an ECG machine and a blood pressure cuff.
They stand on a treadmill and there is a gradual increase in exercise until:
-the target heart rate is reached
-chest pain occurs
-other problems occur
-ECG changes occur

26
Q

What is a myocardial infarction?

A

A complete occlusion of a coronary vessel that causes an infarct/death of myocardium.

27
Q

What are signs and symptoms of an MI? (7)

A
  • central crushing chest pain
  • nausea
  • pallor
  • sweating
  • vomiting
  • fainting
  • breathlessness
28
Q

What are the two biochemical markers that can be detected in the blood to distinguish between and NSTEMI and unstable angina?

A
Troponin 
Creatine kinase (MB)
29
Q

What is the preferred treatment for a STEMI?

A

Percutaneous coronary intervention (PCI) - blow up a balloon inside a vessel so that the plaque is compressed. Insert a meshwork to keep the vessel dilated.

30
Q

What are the two methods of Revascularisation?

A

Percutaneous coronary intervention (PCI)

Coronary artery bypass grafting (CABG)

31
Q

What are the two groups of drugs given to treat NSTEMIs and unstable angina? Give an example of each.

A
  • anticoagulants - heparin

- anti-platelet agent - aspirin

32
Q

What are 5 causes of acute pericarditis?

A
  • infection
  • post MI/ cardiac surgery
  • autoimmune
  • uraemia (kidney failure)
  • malignant deposits
33
Q

What are 3 symptoms of acute pericarditis?

A
  • central/left sided chest pain
  • sharp, worse with inspiration
  • improved by leaning forwards
34
Q

What are the three cardiovascular causes of chest pain?

A

Pericarditis
Myocardium- angina, MI
Aorta- aortic dissection