Flashcards in Chest Pain And IHD Deck (30):
What type of pain defines myocardial ischaemia?
What type of pain defines pericarditis?
What type of pain defines aortic dissection?
What does pleuritic pain mean?
When the patient breathes in, the pain gets worse
What direction does blood flow occur in the heart?
Epicardium to endocardium
Which part of the cardiac muscle is most vulnerable to ischaemia?
Sub endocardial muscle
Name 3 non-modifiable risk factors for CAD
Name 6 modifiable risk factors for CAD
Lack of exercise
Describe a stable plaque
Small necrotic core with thick fibrous cap
Less likely to fissure/rupture
Describe a vulnerable plaque
Large necrotic core with thin fibrous cap
Likely to fissure - expose thrombogenic material in the core
What percentage does the lumen have to be occluded by to cause angina?
How do we diagnose stable angina?
Exercise stress test - ST segment depression
Resting ECG usually normal
Present with risk factors usually
Sublingual nitrates/rest should relieve symptoms
What types of long term medication may be given for stable angina?
Long acting nitrates
Calcium channel blockers
What does PCI stand for?
Percutaneous coronary intervention
(Angioplasty and stent)
Which vessels can we use for a bypass?
Internal thoracic artery
Great saphenous vein
How do we diagnose unstable angina?
No biomarkers for cardiac necrosis
Could have normal ECG/T inversion/ST depression
Pain not relieved as quickly by rest
More severe pain
What are the biomarkers for cardiac damage?
Cardiac troponin I
Cardiac troponin T
What are the ECG changes in fully evolved STEMI?
Pathological Q waves
ST segment elevation
T wave inversion
Define pathological Q waves
Greater then 1 small square wide
Greater than 25% of QRS complex deep
Which ECG leads show an inferior infarction and which artery is most likely occluded?
II, III and aVF
Which ECG leads show an anteroseptal infarction and which artery is most likely occluded?
Which ECG leads show an anteroapical infarction and which artery is most likely occluded?
Which ECG leads show an anterolateral infarction and which artery is most likely occluded?
I, aVL and V5-V6
Which ECG leads show an extensive anterior infarction and which artery is most likely occluded?
I, aVL, V1-V6
Which ECG leads show a posterior infarction and which artery is most likely occluded?
Tall R wave in V1
When does cardiac troponin begin to rise and fall?
Rise about 4 hours after onset of pain
Declines slowly 10-14 days after
Where is creatine kinase normally present?
Which isoenzyme of creatine kinase is specific to the heart?
When does creatine kinase begin to rise and fall?
Rises 3-8 hours after onset of pain
Back to normal in 48-72 hours