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Flashcards in Coronary Heart Disease Overview Deck (29)
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1

Sudden death and CHD?

50% of deaths are sudden
2/3 of these being 1st manifestation / low risk

2

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

3

Modifiable factors for having cardiac arrest?

Genetic profile
Drugs/electrolytes
Ischemic burden
Hemodynamic fluctuations
Autonomic variations

4

What is cardiogenic shock?

Inadequate system perfusion as a result of cardiac dysfunction

5

What can cause cardiogenic shock?

Acute MI-multivessel disease percluded LAD
Mechanical complications

6

How do you diagnose angina?

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

7

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

8

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

9

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

10

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
Oesophageal spasm
Biliary colic

11

Differential diagnosis for chest pain in regards to musculoskeletal pain?

Injury- location, prolonged, exact
Nerve root pain- prolonged, character

12

Other differential diagnosis of chest pain?

Pericarditis - central, posture related
Pleuritic pain- focal exacerbated by breathing, sharp/catching

13

Emergency syndromes?

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

14

If a patient described what would it be?
Pressing pain in exercise but can resume after 5 mins

Angina

15

Angina can be tested for. True or False?

False. Angina is a CLINICAL diagnosis

16

when can people can have angina without coronary disease?

Anaemia

17

Pros of exercise testing?

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

18

Cons of exercise test?

Poor diagnostic accuracy in important sub-groups (women)
Submaximal tests

19

Pros of perfusion imaging?

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

20

Cons of perfusion imaging?

Radiation
False positives and negatives

21

Pros of CT angiography?

Non-invasive
Anatomical data and risk stratification

22

Cons of CT angiography?

Radiation
Less precise than angiography, particularly when calcium present
Cost

23

What is the gold standard test for angina?

Angiography

24

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

25

Pros of angiography?

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

26

Cons of angiography?

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

27

How to reduce risk of CHD?

Drugs
lifestyle Revascularization

28

Drugs to use for CHD?

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

29

Lifestyle advice for CHD?

STOP SMOKING
Take exercise
Healthy balances diet