Flashcards in Coronary Heart Disease Overview Deck (29)
Sudden death and CHD?
50% of deaths are sudden
2/3 of these being 1st manifestation / low risk
Development of cardiac arrest?
-Stable plaque->unstable plaque->Transient ischemia=CA
- Acute occlusion-> Acute MI=CA
-Chronic closure->scar formation =CA or Ischemic Cardiomyopathy = CA
Modifiable factors for having cardiac arrest?
What is cardiogenic shock?
Inadequate system perfusion as a result of cardiac dysfunction
What can cause cardiogenic shock?
Acute MI-multivessel disease percluded LAD
How do you diagnose angina?
It is a clinical diagnosis- can be confirmed by history, examination not tests
Clinical diagnosis of angina?
-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
Patient could describe angina as?
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
Patient symptoms which indicate muscuoskeletal pain?
Dull, knifelike stabbing
Fleeting or prolonged
Focal- left submammary in shoulder
No pattern, can be at rest
No risk factors
Differential diagnosis fro chest pain relating to the GI tract?
Reflux, burning, acid, water brash- provoked by food
Peptic ulcer pain- boring,Point of ginger gesture,relief by antacids
Differential diagnosis for chest pain in regards to musculoskeletal pain?
Injury- location, prolonged, exact
Nerve root pain- prolonged, character
Other differential diagnosis of chest pain?
Pericarditis - central, posture related
Pleuritic pain- focal exacerbated by breathing, sharp/catching
Myocardial Infarction - prolonged, severe
Pulmonary Embolus - breathlessness, dull
Dissection of aorta - tearing,excruciating, severe then eases
If a patient described what would it be?
Pressing pain in exercise but can resume after 5 mins
Angina can be tested for. True or False?
False. Angina is a CLINICAL diagnosis
when can people can have angina without coronary disease?
Pros of exercise testing?
Risk stratification - +ve test at low workload implies poor prognosis
Cons of exercise test?
Poor diagnostic accuracy in important sub-groups (women)
Pros of perfusion imaging?
Pharmacological stress in less mobile patients
More precision than ETT
Cons of perfusion imaging?
False positives and negatives
Pros of CT angiography?
Anatomical data and risk stratification
Cons of CT angiography?
Less precise than angiography, particularly when calcium present
What is the gold standard test for angina?
Process of angiography?
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
Pros of angiography?
Anatomical and risk stratification
Cons of angiography?
Risk 1:1000 death, stroke
Contrast: renal dysfunction, rash, nausea
How to reduce risk of CHD?
Drugs to use for CHD?
B blockers- Slow heart rate, reduce O2 demand
ACE Inhibitors-reduce BP