Flashcards in *Ischaemic Heart Disease (1) Deck (42)
What are 2 other names interchangeable with ischaemic heart disease?
Coronary artery disease
Coronary heart disease
What is ischaemic heart disease?
When the coronary artery blood flow becomes restricted secondary to an accumulation of atherosclerotic plaque (myocardial ischaemia may be less frequently reduced due to other conditions such as coronary arterial spasm)
When does ischaemia occur?
When myocardial oxygen demand exceeds supply, often presenting as chest pain
Difference between ischaemia and infarction?
Ischaemia = reduced blood supply
Infarction = cell death due to ischaemia
What is sudden cardiac death (SCD)?
Sudden cardiac arrest with no warning or within 1 hour of onset of symptoms
What are 3 things that have been associated with IHD presenting with SCD?
Familial trait with sudden death as first manifestation of IHD
Association between long QT interval and SCD in IHD
Incidence is much higher in patients who have had runs of VT post MI
What is a heart attack (MI)?
Death of heart muscle tissue due to loss of blood supply
What causes death due to an MI? (2)
Arrhythmias - commonly VF
Severely damaged heart muscle
What is ischaemic cardiomyopathy?
A type of dilated cardiac myopathy caused by narrowing of the coronary arteries. In this condition the heart muscle is weakened. In this condition, the left ventricle, which is the main heart muscle, is usually enlarged and dilated.
What can an unstable plaque lead to?
How does this lead to SCD?
During repercussion, there is lengthening of the time course of depolarisation = long QT which can lead to the formation of arrhythmias and cardiac arrest
What is cardiogenic shock?
Inadequate systemic perfusion as a result of cardiac dysfunction
What is angina?
Clinical manifestation of myocardial ischaemia which is typically characterised by central crushing chest pain on exertion that is relieved by rest
Where can pain from angina be felt? (5)
Radiating to arm(s), back, neck, jaw, teeth
What are some examples of angina triggers? (4)
Some GI tract problems which could be a differential diagnosis of chest pain?
Peptic ulcer pain
Biliary colic (unusual to be confused with angina)
Differential diagnosis for chest pain? (4)
GI tract e.g. reflux, oesophageal spasm
What is angor animi?
Symptom defined as a patient's perception that they are dying
3 emergency conditions that can cause chest pain?
Dissection of aorta (tearing, excruciating, severe then eases)
How is angina usually diagnosed?
Can patients have coronary artery disease without angina?
Can patients have angina without coronary artery disease?
A patient can have coronary artery disease without angina or angina without coronary artery disease
What is an alternative to an exercise ECG looking for coronary artery disease in less mobile patients?
Myocardial perfusion imaging
4 possible tests to look for coronary artery disease?
Myocardial perfusion scan
What are some of the problems caused by the contrast used in angiography? (3)
What is the difference between angiography and CT angiography?
In angiography dye is injected into the blood vessels and a series of images are taken (more invasive but more reliable)
In CT angiography is basically a CT scan that looks at the blood vessels after dye is injected (non-invasive but less precise especially if calcium present)
Relieving symptoms of IHD?
Lifestyle (smoking, exercise, diet)
Revascularisation (CABG, PCI)
What is the purpose of beta blockers?
Slow heart rate reducing O2 demand
What vessels tend to be grafted during coronary artery bypass surgery?
Long saphenous vein (leg)
Internal mammary (thoracic) artery (supplies anterior chest wall)
Intentional and temporary cessation of cardiac activity
What can patients experience 8-10 years after getting a coronary artery bypass graft?