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Y2 EMS- Theme 2- Genetic And Environmental Causes Of Disease > 4. Ischaemic Heart Disease And Failure > Flashcards

4. Ischaemic Heart Disease And Failure Flashcards

(51 cards)

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1
Q

What is Ischaemic heart disease (IHD)

A

Inadequate blood supply to heart

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2
Q

What is IHD caused by

A

Reduced coronary blood flow due to atheroma mostly/ can be thrombus
Myocardial hypertrophy- may be due to high b.p n overworking

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3
Q

What percentage of a coronary vessel lumen being occluded would be considered critical stenosis

A

75 % or more

Therefore have symptoms at this stage

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4
Q

What is door to balloon time

A

The time between getting symptoms to getting a coronary angioplasty of the coronary artery

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5
Q

What is the percentage increase in mortality if the door to balloon time is increased over 2 hrs

A

20 percent to 60 percent

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6
Q

After how long after a coronary occlusion would myocardial necrosis be seen

A

30 minutes

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7
Q

How many minutes is considered rapid perfusion (which would prevent cell loss and can limit infraction size/ area of risk)

A

20 mins

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8
Q

What are the three types of angina pectoris

A

Typical/ stable
Crescendo/ unstable
Variant/ prinzmetal

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9
Q

Which types of angina pectoris can happen at rest

A

Crescendo

Variant/ prinzmetal

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10
Q

How can a typical/ stable angina be relieved

A 
By rest (symptoms occur OE)
Nitrate (vasodilator - cos of chronic narrowing due to atherosclerosis)
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11
Q

What can a crescendo angina be caused by

A

Disruption of the atheromatous plaque eg rupture with partial thrombus/ embolism
- happens usually before MI

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12
Q

What causes variant angina pectoris

A

Due to coronary artery spasm, caused by transient myocardial ischaemia
Unrelated to exertion

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13
Q

What is acute coronary syndrome

A

unstable angina, non-ST-segment-elevation myocardial infarction (NSTEMI) and ST-segment-elevation myocardial infarction (STEMI) that are due to a sudden reduction of blood flow to the heart.

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14
Q

What is ST elevation referring to

A 
Abnormality seen in an ECG 
ST segment (interval between ventricular depolarisation and re polarisation) is raised
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15
Q

What can acute ischaemia lead to

A

Trans mural MI

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16
Q

What is a trans mural MI

A

Ischaemi necrosis involves the full thickness of the ventricular wall

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17
Q

What is a subendocardial MI

A

Ischaemia involved a small area (on the inner layers) of teh myocardial wall not all the layers - only the subendocardium

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18
Q

Which type of MI has ST elevation

A

Trans mural

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19
Q

What does STEMI stand for

A

ST-segment elevation myocardial infarction

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20
Q

What does the heart look like at 1 to 2 days of an MI

A

Pale
Odeamatous
Myocyte necrosis
Neutrophils

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21
Q

What does teh heart look like at 3-4 days of an MI

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A

Yellow with haemorrhagic edge
Myoctye necrosis
Macrophages

22
Q

What does the heart look like 1-3 weeks after an MI

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A

Red grey to pale- white
Thin
Granulation tissue then fibrosis

23
Q

3 to 6 weeks of an MI, heart looks like?

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A

Dense fibrous scar

24
Q

What can cause a subendocardial MI

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A

Plaque rupture
Coronary thrombosis where the necrosis doesn’t spread full thickness

Prolonged reduction in systemic blood pressure

25
Hypotensive meaning
Abnormally low blood pressure
26
In which people may an MI be silent/ atypical
Women Elderly Diabetics
27
Tests for MI
``` ECG Cardiac enzymes Echo Angio Pulse, breathing ```
28
What are cardiac enzymes and when can they leak out
Blood markers of cardiac myocyte damage that leak out when myocytes become damaged
29
Give 5 examples of cardiac enzymes
``` Tropnonins T and I Creatine kinase MB Myoglobin Lactate dehydrogenase isoenzmye 1 Aspartate trasnaminase ```
30
Why might the cardiac enzyme aspartate transaminase be a less useful marker of myocardial damage
It is also present in the liver
31
What do troponins T and I do
Regulate Ca mediated contraction | Tissue specific
32
When are levels of troponins T and I raised
Post MI PE Heart failure Myocarditis
33
What else apart from teh heart is myoglobin also released from
Damaged skeletal muscle
34
Treatment of MI
``` MONA= Morphine Oxygen Nitrates Aspirin Reperfusion (eg, PCI, balloon angioplasty, stenting, coronary artery bypass grafting) ```
35
What that is the main aim of the treatment given for an MI
Reduce total ischamic time
36
What treatment can be given as a secondary prevention for MI
Ace- I = help to dilate vessel Anti platelets = stops platelets from sticking - reduce clot formation Anticogaltion = slow process of clot formation Antiarrhythmics= restore normal heart rhythm Beta blockers = reduce activity of the heart Statins = lower blood choesltrol levels
37
What % of MIs are fatal
Over 35%
38
What % of fatal cardiac deaths are sudden cardiac deaths (in 1 to 2 hrs)
70%
39
Who may be at more risk of MI
Women Elderly Diabetics Had a previous MI
40
How can an MI cause a myocardial rupture
Due to weakening of the necrotic muscle
41
What is tamponade
Compression of the heart by an accumulation of fluid in the pericardial sac
42
What is an aneurysm
Excessive localised swelling of an artery wall
43
What is chronic IHD
Progressive heart failure due to ischaemic myocardial damage
44
What is familial hypercholestrolaemia
Mutations in genes involved in cholesterol metabolism: - low density lipoprotein receptor gene - apoliprotein B
45
Symptoms of familial hyper cholesterolaemia in heterozygotes and thier treatment
Xanthomas = yellow patch/ nodule on skin caused by lipid deposition Periocular corneal arcus Early progressive atherosclerosis Treatment = statins (hydroxymethyl CoA reductase inhibtors)
46
What is heart failure
Heart is unable to pump blood at required demand | End stage of all disease of the heart
47
In the western world what are the two most common causes of HF
Coronary artery disease (CAD) | Hypertension
48
Symptoms/ signs of HF
``` Dilated pupils Infarct Low bp Weak pulse Pitting oedema Confusion Falling 02 saturation Cough Dyspnea Orthopnea etc. ```
49
Give some causes of HF
CAD Hypertension Alcohol and drugs Cardiomyopathy etc.
50
Investigation for HF
``` Initial: CXR ECG Echo Bloods ```
51
What does the New York Classifaction of heart failure severity do
Tells us about survival probability Four classes: ``` I= no symptoms, normal functional status II= mild symptoms with normal activity, comfy at rest, slight limit of functionality III= moderate symptoms IV= sever symptoms even at rest, sever limitation of functional status ```

Y2 EMS- Theme 2- Genetic And Environmental Causes Of Disease (7 decks)

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