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Flashcards in Ischaemic heart disease Deck (17)

What is ischaemic heart disease?

Reduced blood supply to the heart muscle secondary to coronary artery disease.


What are the risk factors for ischaemic disease?

• Smoking • Diet • Cholesterol • Diabetes • Hypertension
• Family History


What's the clinical spectrum of ischaemic heart disease?

stable angina to unstable angina to NSTEMI (the supply of blood to the heart is partially blocked) to STEMI (a long interruption to the blood supply. This is caused by a total blockage of the coronary artery)


What is angina?

• Exertional Chestpain - classically central & retrosternal - radiates to jaw & arms - passes with rest
• Exertional dyspnoea


What's the medical therapy for ischaemic heart disease?

• Modification of Risk Factors - weight loss
- blood pressure control - diabetic therapy - smoking cessation
• Aspirin • Statins • Betablockers/CCBs/Ivabradine • ACE Inhibitors • Anti-anginals – nitrates/nicorandil.
COURAGE: Clinical Outcomes Utilizing Revascularization and Aggressive Guideline-Driven Drug Evaluation


What could be done once screening has taken place to determine whether it's ischaemic heart disease and medication's been given but there's still a problem?

CABG (coronary artery bypass surgery)
PCI percutaneous coronary intervention (catheter, balloon, stent)


What's a myocardial infarction? (MI)

A heart attack. It happens when blood stops flowing properly to part of the heart and the heart muscle is injured due to not receiving enough oxygen. Usually this is because one of the coronary arteries that supplies blood to the heart develops a blockage due to an unstable buildup of white blood cells, cholesterol and fat. The event is called "acute" if it is sudden and serious.


What are the symptoms of a MI?

• Chestpain - classically central tight band - radiation down arms or to jaw
• Nausea/Vomiting • Collapse • Diaphoresis/sweat


What's thrombolysis?

Thrombolysis is the breakdown (lysis) of blood clots by pharmacological means, and commonly called clot busting. It works by stimulating secondary fibrinolysis by plasmin through infusion of analogs of tissue plasminogen activator (tPA), the protein that normally activates plasmin.
It's used for: Myocardial infarction
Stroke (ischemic stroke)
Massive pulmonary embolism
Acute limb ischaemia


What's the treatment for an acute MI?

• Thrombolysis: Pre-Hospital, Hospital
• Percutaneous Coronary Intervention: Primary Facilitated
• Anti-platelet therapy: • Aspirin • Clopidogrel • Glycoprotein 2b3a Inhibitors
• Inserting a stent (stent thrombosis) must not stop clopidogrel when performing this, it's potentially life threatening to carry out.


What is heart failure?

Occurs when the heart is unable to provide sufficient pump action to maintain blood flow to meet the needs of the body.The condition is diagnosed by patient physical examination and confirmed with echocardiography. Blood tests help to determine the cause. Treatment depends on the severity and cause of the heart failure. In a chronic patient already in a stable situation, treatment commonly consists of lifestyle measures such as smoking cessation, light exercise, dietary changes, and medications. Sometimes, depending on etiology, it is treated with implanted devices (pacemakers or ventricular assist devices) and occasionally a heart transplant is required.


What are the symptoms of heart failure?

• Dyspnoea • Orthopnoea • PND • Ankle Oedema • Pulmonary Oedema • Fatigue • Exercise Intolerance


What are the causes of heart failure?

Myocardial infarction (heart attack) and other forms of coronary artery disease, hypertension, valvular heart disease, and cardiomyopathy.[4] The term heart failure is sometimes incorrectly used for myocardial infarction (which may cause heart failure, but is not heart failure in itself) or for cardiac arrest (in which blood flow effectively stops altogether).


What are the different classes of heart failure?

Cardiac disease without exertional limitation
Slight limitation with physical activity
Marked limitation of physical activity
Inability to carry on any physical activity


What's the treatment of acute heart failure?

Acute • Oxygen • CPAP • Diuretics • Vasodilators


What's the treatment for chronic heart failure?

• Diuretics • Betablockers •ACE Inhibitors
• Angiotensin Receptor Blockers • Aldosterone Antagonists • Exercise • Dietary Modification
• Cardiac Transplant


Main thing to remember?

Don't stop clopidogrel without consultation!