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Cardiovascular > Ischaemic Heart Disease > Flashcards

Ischaemic Heart Disease Flashcards

1
Q

what is ischaemic heart disease

A

narrowing of arteries- same as coronary heart disease

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2
Q

can IHD cause sudden death

A

yes but not common

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3
Q

what percentage of IHD deaths common

A

50% (rare as not many deaths from IHD)

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4
Q

what does a family history of CHD put diagnosed patients at greater risk of

A

ventricular fibrillation

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5
Q

what types of plaque causes transient ischemia

A

unstable plaque

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6
Q

what causes an acute MI

A

and acute occusion

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7
Q

what does a chronic closure of an artery cause

A

scar formation

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8
Q

how does scar formation affect the electrical conductivity of the heart

A

can cause ventricle fibrillation as potentially allows re-entrance circuit (as signals circle the scar)

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9
Q

when can a clot cause VF

A

when affecting electrically sensitive area of the heart

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10
Q

how does disordered cardiac muscle fibres affect treatment of fibrillation and cardiomyopathy

A

harder to treat

defibrillation less effective

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11
Q

what is cardiogenic shock

A

Inadequate systemic perfusion as a result of cardiac dysfunction

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12
Q

what circulatory effects does an MI cause

A

build up of pressure in heart and lungs- oedema and systemic inflammation response

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13
Q

what is the key thing to treat in an MI

A

ischaemia

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14
Q

how is angina diagnosed

A

visceral, dull, pain from myocardial hypoxia
gestures (tight fist over/holding chest)

characteristic patterns of
provocation, relief (rest), timing (1-2 mins)

risk factors

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15
Q

describe the pain of angina

A

Pressing, squeezing, heaviness, a weight,

Radiating to arm(s), back, neck, jaw, teeth

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16
Q

what can provoke angina

A

Exertion, stress, cold wind, after meals

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17
Q

what other than rest can relieve angina

A

GTN spray

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18
Q

what are the differential diagnosis of chest pain

A

GI tract (reflux, prptic ulcer, oesophageal spasm, biliary colic)

musculoskeletal (injury, nerve root pain)

pericarditis

pleuritic pain

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19
Q

what causes of chest pain are emergencies

A

MI- severe, ongoing despite morphine

Pulmonary Embolus- breathlessness, dull

dissection of aorta- tearing, excruciating

20
Q

what is associated with autonomic upset

A

sweating, SOB, fear, impending doom

21
Q

does angina always accompany CHD

A

no

22
Q

what is exercise testing

A

BP and ECG recorded during exercise

23
Q

what is perfusion imaging

A

is a non-invasive imaging test that shows how well blood flows through (perfuses) your heart muscle

24
Q

what are the pros and cons of perfusion imaging

A

pros
non invasive more precise than ETT

cons
radiation, false pos and negs

25
Q

what is a CT angiography

A

injecting contrast to get 3d reconstruction of coronary circulation

26
Q

what are the cons of CT angiography

A

less precise than angiography, costly

27
Q

what is ETT

A

exercise tolerance test

28
Q

what is angiography

A

sheath inserted into artery from wrist/groin to coronary ostium

x ray contrat agent injected to outline coronaries

video fluoroscopy recorded in multiple views

29
Q

what are the pros and cons of angiography

A

best imaging

cons
risk of death/stroke (low)
radiation
contrast; renal dysfunction, rash, nausea

30
Q

how do you reduce the risks of CHD (death/disability)

A

drugs, lifestyle, revascularisation

31
Q

what drugs are used to treat CHD

A

aspirin- antiplatelets

beta blockers- slow heart rate, reduce o2 demand

statin- reduces cholesterol

ACE inhibitor- reduces blood pressure

32
Q

what is coronary revascularisation

A

restoring blood flow to the heart e.g. coronary artery bypass

33
Q

how is the heart accessed in a coronary artery by pass

A

median sternotomy

34
Q

what vessels are used in a coronary artery bypass

A

Long saphenous vein

Internal Mammary artery

35
Q

what is cardioplegia

A

temporary cessation of cardiac activity

36
Q

what are the complications of coronary artery bypass

A

death, stroke, MI, atrial fibrillation, infection, cognitive impairement, sternal malunion, renal failure

37
Q

define and describe PCI

A

Percutaneous coronary intervention
(angioplasty with stent)

non-surgical procedure that uses a catheter to place a small structure called a stent to open up blood vessels in the heart that have been narrowed by plaque buildup

38
Q

what are the complications of PCI

A

death, stroke, MI, renal failure, bleeding, vascular complications; stent thrombosis or restenosis

39
Q

what is restenosis

A

the recurrence of narrowing of a vessel

40
Q

describe the PCI technique

A 
vascular access 
anti platelet drugs, anticoagulation 
catheter to ostium (opening)of coronary
guidewire down vessel
balloons threaded over wire 
stents implanted 
ballon, catheter and wires removed
41
Q

what makes a patient suitable for revascularisation

A

multi vessel disease
left main disease
diabetes
co-morbidities

42
Q

what are the pros of radial artery access

A

dual supply to hand, superficial, compressible, no adjacent nerve/vein

43
Q

what are the cons of radial artery access

A

smaller, prone to spasm, occlusion

44
Q

what is haematoma

A

solid swelling of clotted blood within the tissues

45
Q

how is a STEMI revascularised

A

PCI

46
Q

what is acute coronary syndrome and how is it revascularised

A

any group of clinical symptoms compatible with acute myocardial ischemia and includes unstable angina (UA), non—ST-segment elevation myocardial infarction (NSTEMI), and ST-segment elevation myocardial infarction (STEMI).

angiography with a view to revascularisation

Cardiovascular (34 decks)

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