Coronary Heart Disease Overview Flashcards

1
Q

Sudden death and CHD?

A

50% of deaths are sudden

2/3 of these being 1st manifestation / low risk

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2
Q

Development of cardiac arrest?

A
  • Stable plaque->unstable plaque->Transient ischemia=CA
  • Acute occlusion-> Acute MI=CA
  • Chronic closure->scar formation =CA or Ischemic Cardiomyopathy = CA
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3
Q

Modifiable factors for having cardiac arrest?

A
Genetic profile
Drugs/electrolytes
Ischemic burden 
Hemodynamic fluctuations 
Autonomic variations
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4
Q

What is cardiogenic shock?

A

Inadequate system perfusion as a result of cardiac dysfunction

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5
Q

What can cause cardiogenic shock?

A

Acute MI-multivessel disease percluded LAD

Mechanical complications

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6
Q

How do you diagnose angina?

A

It is a clinical diagnosis- can be confirmed by history, examination not tests

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7
Q

Clinical diagnosis of angina?

A
  • Visceral pain from myocardial hypoxia - hard to describe, Gestures
  • Characteristic patterns of Provocation-exertion,cold, relief, timing (goes away when exertion stops)
  • Characteristic background–risk factors
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8
Q

Patient could describe angina as?

A

Pressing, squeezing, heaviness, a weight
Radiating to arm, back, neck, jaw and teeth
Causes=Exertion stress, cold wind, after meals
Few minutes of rest relief it

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9
Q

Patient symptoms which indicate muscuoskeletal pain?

A
Dull, knifelike stabbing 
Fleeting or prolonged 
Focal- left submammary in shoulder 
No pattern, can be at rest 
No risk factors
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10
Q

Differential diagnosis fro chest pain relating to the GI tract?

A

Reflux, burning, acid, water brash- provoked by food
Peptic ulcer pain- boring,Point of ginger gesture,relief by antacids
Oesophageal spasm
Biliary colic

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11
Q

Differential diagnosis for chest pain in regards to musculoskeletal pain?

A

Injury- location, prolonged, exact

Nerve root pain- prolonged, character

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12
Q

Other differential diagnosis of chest pain?

A

Pericarditis - central, posture related

Pleuritic pain- focal exacerbated by breathing, sharp/catching

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13
Q

Emergency syndromes?

A

Myocardial Infarction - prolonged, severe
Pulmonary Embolus - breathlessness, dull
Dissection of aorta - tearing,excruciating, severe then eases

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14
Q

If a patient described what would it be?

Pressing pain in exercise but can resume after 5 mins

A

Angina

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15
Q

Angina can be tested for. True or False?

A

False. Angina is a CLINICAL diagnosis

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16
Q

when can people can have angina without coronary disease?

A

Anaemia

17
Q

Pros of exercise testing?

A

Cheap
Reproducible
Risk stratification - +ve test at low workload implies poor prognosis

18
Q

Cons of exercise test?

A

Poor diagnostic accuracy in important sub-groups (women)

Submaximal tests

19
Q

Pros of perfusion imaging?

A

Non invasive
Pharmacological stress in less mobile patients
More precision than ETT
Risk stratification

20
Q

Cons of perfusion imaging?

A

Radiation

False positives and negatives

21
Q

Pros of CT angiography?

A

Non-invasive

Anatomical data and risk stratification

22
Q

Cons of CT angiography?

A

Radiation
Less precise than angiography, particularly when calcium present
Cost

23
Q

What is the gold standard test for angina?

A

Angiography

24
Q

Process of angiography?

A

Sheath inserted into artery
Catheter advanced from wrist / groin to coronary ostium
X-ray contrast agent injected to outline coronaries
Video fluoroscopy recorded images in multiple views

25
Q

Pros of angiography?

A

“Gold standard”
Anatomical and risk stratification
Follow-on angioplasty

26
Q

Cons of angiography?

A

Risk 1:1000 death, stroke
Radiation
Contrast: renal dysfunction, rash, nausea

27
Q

How to reduce risk of CHD?

A

Drugs

lifestyle Revascularization

28
Q

Drugs to use for CHD?

A

Aspirin- antiplatelet
B blockers- Slow heart rate, reduce O2 demand
Statins-Reduces cholesterol
ACE Inhibitors-reduce BP

29
Q

Lifestyle advice for CHD?

A

STOP SMOKING
Take exercise
Healthy balances diet