Ischaemic heart disease Flashcards
(23 cards)
Define cardiogenic shock
Inadequate systemic perfusion as a result of cardiac dysfunction
What is the clinical diagnosis of angina?
Visceral pain from myocardial hypoxia.
Characteristic patters of provocation, relief and timing.
Characteristic background of risk factors.
How might a patient describe the pain they are experiencing with angina?
Pressing, squeezing, heaviness, a weight
Where may the pain radiate?
Arm(s), back, neck, jaw and teeth
What might provoke the angina?
Exertion, stress, cold wind and after meals
How long does the pain last?
A few minutes, and is relieved by GTN spray
Give some GI causes of chest pain
Reflux (provoked by food)
Peptic ulcer pain
Oesophageal spasm
Bililary colic
Give some musculoskeletal causes of chest pain
Injury (movement)
Nerve root pain
What are two other differential diagnosis of chest pain?
Pericarditis (central, posture related) Pleuritic pain (focal, exacerbated by breathing, sharp, catching)
Describe the pain experienced with an MI
Severe, ongoing (despite >10mg morphone)
What are the symptoms of pulmonary embolus?
Breathlessness
Stony dull on percussion
Describe the pain experienced with dissection of the aorta
Tearing, excruciating, severe then eases
What are the advantages of exercise testing?
Cheap, reproducible
What are the disadvantages of exercise testing?
Poor diagnostic accuracy is important sub-groups and submaximal tests
What is perfusion scanning?
Look at images of the heart after a radioactive tracer has been put in the blood. The tracer is taken up by the myocardium. The areas that do not light up do not have a good blood supply.
What are the advantages of perfusion imaging?
Non invasive, more precise that ETT and less stress is less mobile patients
What are the disadvantages of perfusion imaging?
Radiation exposure and false positives and negatives
What is CT angiography?
A medical exam that combines a CT scan with an injection of contrast to allow produce pictures of the blood vessels
What are the advantages of CT angiography?
Non invasive and risk stratification
What are the disadvantages of CT angiography?
Radiation, less precise than angiography and cost
What is angiography?
Sheath inserted into artery, X-ray contrast agent is injected to outline the coronaries, video fluoroscopy recorded images in multiple views
What are the advantages of angiography?
Gold standard
Anatomical and risk startification
What are the disadvantages of angiography?
Risk of death, stoke
Radiation
Contrast can cause renal dysfunction, rash and nausea
