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Flashcards in Chest Pain And IHD Deck (30):
1

What type of pain defines myocardial ischaemia?

Tightening

2

What type of pain defines pericarditis?

Sharp

3

What type of pain defines aortic dissection?

Tearing

4

What does pleuritic pain mean?

When the patient breathes in, the pain gets worse

5

What direction does blood flow occur in the heart?

Epicardium to endocardium

6

Which part of the cardiac muscle is most vulnerable to ischaemia?

Sub endocardial muscle

7

Name 3 non-modifiable risk factors for CAD

Increasing age
Male gender
Family history

8

Name 6 modifiable risk factors for CAD

Hyperlipidaemia
Cigarette smoking
Hypertension
Diabetes mellitus
Lack of exercise
Obesity

9

Describe a stable plaque

Small necrotic core with thick fibrous cap
Less likely to fissure/rupture

10

Describe a vulnerable plaque

Large necrotic core with thin fibrous cap
Likely to fissure - expose thrombogenic material in the core

11

What percentage does the lumen have to be occluded by to cause angina?

70%

12

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

13

What types of long term medication may be given for stable angina?

Long acting nitrates
Beta blockers
Calcium channel blockers
Statins
Aspirin

14

What does PCI stand for?

Percutaneous coronary intervention
(Angioplasty and stent)

15

Which vessels can we use for a bypass?

Internal thoracic artery
Radial artery
Great saphenous vein

16

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

17

What are the biomarkers for cardiac damage?

Cardiac troponin I
Cardiac troponin T
Creatine kinase

18

What are the ECG changes in fully evolved STEMI?

Pathological Q waves
ST segment elevation
T wave inversion

19

Define pathological Q waves

Greater then 1 small square wide
Greater than 25% of QRS complex deep

20

Which ECG leads show an inferior infarction and which artery is most likely occluded?

II, III and aVF
RCA

21

Which ECG leads show an anteroseptal infarction and which artery is most likely occluded?

V1-V2
LAD

22

Which ECG leads show an anteroapical infarction and which artery is most likely occluded?

V3-V4
LAD (distal)

23

Which ECG leads show an anterolateral infarction and which artery is most likely occluded?

I, aVL and V5-V6
Circumflex

24

Which ECG leads show an extensive anterior infarction and which artery is most likely occluded?

I, aVL, V1-V6
LCA

25

Which ECG leads show a posterior infarction and which artery is most likely occluded?

Tall R wave in V1
RCA

26

When does cardiac troponin begin to rise and fall?

Rise about 4 hours after onset of pain
Declines slowly 10-14 days after

27

Where is creatine kinase normally present?

Skeletal muscle
Heart
Brain

28

Which isoenzyme of creatine kinase is specific to the heart?

CK-MB

29

When does creatine kinase begin to rise and fall?

Rises 3-8 hours after onset of pain
Back to normal in 48-72 hours

30

What are the 3 groups of drugs used in ACS and how do they differ?

Fibrinolytic - dissolve thrombus, activate plasmin
Antiplatelet - prevent thrombosis, acting on platelet pathway
Anticoagulant - prevent thrombosis, act on coagulation cascade