Flashcards in Coronary Artery Disease Deck (30)
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1
Myocardial Ischaemia
Myocardial demand for O2 and Nutrients outstrips supply.
2
Two disease groups where main pathophysiology is myocardial ischaemia
Stable Angina
Acute Coronary Syndrome
3
3 Types of Angina
Exersional angina pectoris
Varient Angina
Cardiac Syndrome X
4
3 Diseases in Acute Coronary Syndrome
ST Elevation Myocardial Infarction
NSTEMI
Unstable Angina
5
Mechanism of myocardial Ischaemia
Mechanical vessel obstruction
Systemic reduction oxygenated blood flow
6
Local causes of myocardial ischaemia
Atheroma
Thrombosis
Arterial Spasm
Embolus
Coronary Arteritis
Coronay Ostial Stenosis
7
Systemic causes myocardial ischaemia
anaemia
carboxyhaemoglobulinaemia
hypotension
8
Risk factors Coronary artery disease
+ Age
Male
+ family Hx
Smoker
Obesity
High Fat Diet
Sedentary Lifestyle
Psychological stressors
High Alcohol intake
Coagulopathies
NSAIDs -COXIBS
9
calculate risk 5 yearly using ....
QRISK3
>10% statins
<10% lifestyle optimisation
10
Angina features
(is clinical diagnosis)
"Cardiac" chest pain
Central/retrosternal pain
sweating
anxiety with attacks
breathlessness
11
Classical Angina Pectoris
angina pain
provoked by exercise (esp after food/in cold/ emotional)
relieved with rest / GTN
12
Varient Angina (/ Prinzmetal's A)
angina pain
at rest
caused by arterial spasm
13
Cardiac Syndrome X
angina pain
positive exercise test
normal coronary arteries on angiography
14
Angina Investigations
in V High risk patients, likely angina and low risk population
BP: screen comorbid HTN
Bloods: FBC, Cholesterol TFT
ECG: normal between attack
Echo:Screen co-morbid abnormality
Ultra High Risk: Cardiac Catheterisation
Probable Angina: SPECT stress testing
Low risk group: CT angiography
15
Angina Managment
Patient education: lifestyle management, employment, sex, risk
Symptomatic Relief: GTN , BBlocker/CCB
(2nd Line: long active nitrate/ rate control/vasodilator)
Cardiac prevention: Statin, 75mg Asprin (OR cloplidigrel post stroke TIA) (+ ACE inhibitor if DM. CKD, CF)
Treatment resistance = dual therapy with BBlocker AND CCB / referral for revascularisation (PCI/CABG)
16
Unstable Angina
Angina pain:
At rest / prolonged in nature / chreschendoing
NO RISE TROP
17
MI Diagnosis
Prolonged myocardial ischaemia causing death of myocytes.
Trop T >30 @ 6 hours or doubling post 3 hours + at least one of
-Cardiac Pain
-suggestive ECG changes (ST elevation/ q waves)
-recent PCI/CABG
18
Management ACS
Morphine 5mg + Antiemetic
Oxygen 2l nasal cannula (unless COPD etc)
Nitrates GTN
Asprin 300mg
Beta Blocker
Access for revascularistation - Revascularise if suitable
if not suitable
ACE Inhibitor,
Statin
Heparin (Fondaparinux)
19
Revascularisation Options
STEMI / High risk consider for revacularisation
If <12 hours and can have PCI within 2 hours: PCI
If not Fibrinolysis. Alteplase / streptokinase
High risk of complications CABG
20
PCI for Angina
Balloon dilatation and stent induction.
21
Anterior MI
Left Anterior Descending artery
Major cardiac supply
22
Anterior MI ECG signs
ST elevation: in V1-V6 +/- 1 +/- aVL
Tombstoning
Isolated J point elevation
23
Inferior MI ECG signs
ST elevation: II, III, aVF
ST suppression in I & aVL
24
Posterior MI ECG signs
ST depression in v1-v4
R:S wave >1
Posterior ECG ST elevation leads v7-v9
25
New LBBB
STEMI treatment
26
NSTEMI ECG
May be normal
ST depression +/- T wave inversion
27
ST depression in v1-v4
R:S wave >1
Posterior ECG ST elevation leads v7-v9
Posterior MI
28
ST elevation: II, III, aVF
ST suppression in I & aVL
Inferior MI
29
ST elevation: in V1-V6 +/- 1 +/- aVL
Tombstoning
Isolated J point elevation
Anterior MI
30
