CVS S10 - Ischaemic Heart Disease Flashcards Preview

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Flashcards in CVS S10 - Ischaemic Heart Disease Deck (36):
0

What are the general common sources of chest pain?

Lungs & Pleura
GI system
Chest wall
CVS - heart & great vessels

1

Give examples of conditions originating in the lungs and pleura which can cause chest pain

Pneumonia
Pneumothorax
Pulmonary embolism

2

Give examples of conditions originating in the GI system which can cause chest pain

Oesophagus (reflux)
Peptic ulcer disease
Gall bladder (cholecystitis, biliary colic)

3

Give examples of conditions originating in the chest wall which can cause chest pain

Fractured ribs
Muscles
Skin

4

Give examples of conditions originating in the CVS which can cause chest pain

Myocardium - angina, MI
Pericardium - pericarditis
Aorta - aortic dissection

5

Give some non-modifiable risks for coronary atheroma (and by extension, IHD)

Increasing age
Gender
Genetics (family history)

6

Give some modifiable risks for coronary atheroma (and by extension, IHD)

Hyperlipidaemia
Smoking
Hypertension
Diabetes mellitus
Exercise
Obesity
Stress

7

Describe ischaemic chest pain

Central, retrosternal or left-sided
Described as crushing, tightening, heavy, constricting
Can radiate along jaw, arm, neck and back (particularly left side of all)

8

Is IHD-caused chest pain always the same?

Can be different in different people
Can have radiation or not, can be only referred pain, can vary in intensity, duration, precipitating and relieving factors

9

Describe stable angina

Mild to moderate IHD chest pain brought on by exertion or emotion, particularly after meals or in cold weather
Relieved by rest
Occurs when >70% of the lumen of a coronary artery is occluded by an atheromatous plaque

10

How is angina treated?

Acutely: sub-lingual GTN spray
Preventatively: beta blockers, Ca channel blockers, oral nitrates
Preventing cardiac events: aspirin, statins, ace inhibitors
Long term: consider revascularisation

11

Describe unstable angina

Ischaemic chest pain which occurs at rest or with minimal exertion. Described as severe and as having a crescendo pattern (becoming distinctly more severe, prolonged or frequent than before)
Caused by worsened stable angina as plaques grow and more coronary lumen is occluded

12

How would a patient with an MI present?

With very serious ischaemic chest pain at rest
Not alleviated by rest or GTN spray
May have no precipitant
Autonomic features eg sweating pallor nausea vomiting
Breathlessness and fainting due to LV dysfunction

13

How does a myocardial infarction occur?

Complete occlusion of a coronary artery leads to ischaemia and infarction of the myocardium it supplies
The fibrous cap of an atheromatous plaque can erode or fissure, allowing blood to the necrotic core & causing thrombus formation which can completely occlude a coronary artery

14

What are the two general categories of myocardial infarction?

STEMI
NSTEMI

15

Describe a STEMI

A myocardial infarction where the ST wave on an ECG is elevated, leading to the abbreviation (ST Elevated Myocardial Infarction)
Occurs when the infarct is the full thickness of the myocardium

16

Describe a NSTEMI

An MI where the ST wave of an ECG is not elevated
Occurs when the infarct is not the full thickness of the myocardium

17

Discuss the diagnosis of angina

ECG is usually normal so an exercise stress test is used
Diagnosis is based on history so these may contribute to diagnosis:
High BP
Corneal arcus
Evidence of atheroma elsewhere eg peripheral vascular disease
LV dysfunction

18

Describe an exercise stress test

Graded exercise whilst connected to an ECG until:
-Target heart rate reached
-Chest pain
-ECG changes
-Other problems (arrhythmia, low bp, ect)

19

What constitutes a positive exercise stress test result for diagnosis of angina?

ST depressions of >1mm

20

What is acute coronary syndrome?

A group of symptoms attributed to the obstruction of coronary arteries as a result of NSTEMI, STEMI or unstable angina

21

How can an unstable arrhythmia be differentiated from an NSTEMI?

UA has no myocardial necrosis whereas NSTEMI has some
So UA would have no bio markers like troponin in the blood but an NSTEMI would have a small amount
In an ECG, there may or may not be a difference

22

How can a STEMI be differentiated from an NSTEMI?

An NSTEMI has partially occluded coronary arteries whereas a STEMI would have complete occlusion
A STEMI would also have significantly more necrosis than an NSTEMI so significantly more troponin and CK bio marker release
On an ECG, a STEMI would show ST elevation but NSTEMI wouldn't

23

What does a deep or pathological q wave indicate?

A previous myocardial infarction which has since healed

24

What troponin isotopes are looked for in suspected MI? Discuss timescales of appearance

Cardiac troponin I (cTnI) and T (cTnT)
Rise 3-4h after onset of ischaemic chest pain
Peak 18-36h after
Slowly decline over the next 10-14 days

25

What creatine kinase isotopes are looked for in suspected MI? Discuss timescales of appearance

CK-MB is the cardiac iso-enzyme
Rises 3-8h after onset of ischaemic chest pain
Peaks after 24h
Returns to normal in 48-72h

26

Give examples of bio markers seen in the blood after an MI

Troponin (types I and T)
Creatine kinase (the MB isoenzyme)

27

What does presence of CK-MB, cTnI or cTnT in the blood indicate?

There has been death of myocardium

28

How may progression of thrombosis be achieved?

Anti platelet agents eg aspirin
Anticoagulants eg heparin

29

How may perfusion be restored to partially occluded vessels?

Early percutaneous coronary intervention (PCI) aka angioplasty
Coronary artery bypass graft (CABG)

30

What medications are used in ischaemic heart disease?

ACE-inhibitors
Beta-blockers
Statins
Organic nitrates
Pain control
Oxygen

31

Describe an angiography

Can be used to view any vessel occlusions
The findings of this procedure may be used to make choices about revascularisation surgeries

32

Describe percutaneous coronary intervention (PCI)

Angioplasty and stenting
A balloon is inflated in the occluded vessel to increase lumen diameter
A mesh stent is expanded simultaneously, which holds the vessel open

33

Describe coronary bypass grafting

Involves taking a blood vessel from elsewhere in the body eg internal mammary artery, radial artery, reversed saphenous vein
This vessel is then grafted onto the heart to provide blood flow around an occlusion

34

Give the typical presentation of acute pericarditis

Central or left-sided chest pain
Sharp pain which is worse on inhalation
Pain is relieved by leaning forward

35

What can cause acute pericarditis?

Infection (viral, TB)
Post MI or cardiac surgery
Autoimmune
Uraemia (kidney failure)
Malignant deposits