Heart Disease Flashcards
(25 cards)
Long term consequences of coronary heart disease
Heart failure, arrhythmias
Clinical diagnosis of angina
Visceral pain from myocardial hypoxia, characteristic patterns and characteristic background
Gestures patients can use when describing pain in angina
Hands up to the chest or jaw, perhaps making a fist or imitating a squeezing motion
Characteristic patterns in angina
Provocation - running for a bus, cold day, windy day, on exertion
Relief - goes away within a few minutes of stopping or by GTN use
Timing - only lasts a very short time
Pain in angina
Pressing, squeezing, heaviness radiating to arm(s), back, jaw, teeth
Emergency cases of chest pain and describe the pain
Myocardial infarction - severe, associated autonomic upset, ongoing pain despite >10mg morphine
Pulmonary embolism - breathlessness, dull (maybe pleuritic) pain
Dissection of aorta - tearing, excruciating pain which is severe then eases
Pros and cons of exercise testing
Pros - cheap, reproducible, risk stratification
Cons - poor diagnostic accuracy in important sub-groups, sub maximal tests
Pros and cons of perfusion imaging
Pros - non-invasive, more precision than exercise testing, risk stratification
Cons - radiation, false positives and negatives
Pros and cons of CT angiography
Pros - non-invasive, anatomical data and risk stratification
Cons - radiation, costly, less precise than angiography, particularly when calcium present
Describe the 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 and cons of angiography
Pros - gold standard, anatomical data and risk stratification, follow-on angioplasty
Cons - risk of stroke or death, radiation, contrast can cause renal dysfunction, rash or nausea
Which tests would you perform on an older patient with typical symptoms of coronary heart disease?
Exercise tolerance test for test and angiography for management
Drugs prescribed to reduce risk and relieve symptoms of coronary heart disease?
Aspirin, anti-platelet, beta blocker, statin, ACE inhibitor
Lifestyle changes someone with coronary heart disease should make
Stop smoking, increase exercise, eat a good diet
Revascularisation options for people with coronary heart disease
CABG, PCI
Surgical technique for coronary artery bypass
- Performed under general anaesthetic
- Median sternotomy
- Long saphenous vein is harvested form leg or mammary artery from back of chest wall
- Patient is placed on cardio-pulmonary bypass
- Cardioplegia is given
- Patient stay overnight in ICU
How long do patients stay in hospital after CABG?
7 days
How long must patients stay off work after CABG?
2-3 months
Complications of CABG
Death, stroke, MI, atrial fibrillation (at least 50% of patients), infection, cognitive impairment, sternal malunion, renal failure, failure to recover
Complications of PCI
Death, stroke, MI, renal failure, bleeding, vascular complications, stent thrombosis, stent restenosis
PCI technique
- Vascular access - tube in artery
- Anti-platelet drugs, anticoagulation (pre treatment)
- Catheter to ostium of coronary
- Guidewire down vessel
- Balloons threaded over wire
- Stent(s) implanted
- Balloon, catheter and wires removed
Indication for angiography
Patient must have severe symptoms and be high risk (STEMI - immediate PCI <30 mins of hospital arrival, STEMI - during hospital admission, high risk stable patients)
What must the patient have to be suitable for revascularisation?
Multi-vessel disease, left main disease, diabetes, comorbidities
What could go wrong in angiography?
Stroke, contrast nephropathy, bleeding, failure of stent (to deliver, to expand, expand without perforation, to remain patent, to treat and prevent future events)
