Ischaemic heart disease Flashcards
Risk factors for IHD
Smoking, diabetes, hypertension, abdominal obesity, lack of fruit/veg, lack of exercise, alcohol, cholesterol
What is a type A behaviour?
Coronary prone behaviour pattern
Competitive, hostile, impatient
Which psychosocial factors are associated with increased risk of CHD?
Type A personality
Depression and anxiety
Psychosocial work characteristics (high demand and low control)
Quantity and quality of social relationships
What causes angina?
Mismatch of oxygen demand and supply
Atherosclerosis
What are the predisposing factors of angina?
Age, smoking, family history, diabetes mellitus, hyperlipidaemia, hypertension, kidney disease, obesity, physical inactivity, stress
What are the exacerbating factors of angina?
Anaemia, hypoxaemia, hypothermia, hypovolaemia
Hypertension, tachyarrhythmia, valvular heart disease, hyperthyroidism, hypertrophic cardiomyopathy
Cold weather, heavy metals emotional stress
What causes the limitation of blood supply in angina?
Impairment of blood flow by proximal arterial stenosis
Increased distal resistance (LVH)
Reduced oxygen-carrying capacity of blood (anaemia)
Name the different types of angina
Prinzmetal’s angina (coronary spasm) - rare
Microvascular angina - downstream resistance rises
Crescendo angina - occurs on minimum exertion
What can be included in the differential diagnosis of angina?
Myocardial ischaemia, pericarditis/myocarditis, PE/pleurisy, chest infection, dissection of aorta, gastro-oesophageal reflux/spasm/ulceration, MSK, psychological
Name the diagnostic tests used for angina
Exercise testing, myoview scan (radioactive tracer), CT scan calcium scoring, CT coronary angiography, stress echo, perfusion MRI, coronary angiography
What medication is used to treat angina?
Aspirin, GTN spray, beta blocker, long acting nitrate, statin, ACE inhibitor, calcium channel blocker, potassium channel opener
How do beta blockers work?
Block tachycardia, reduce conduction in heart, dilate coronary vessels and constrict peripheral vessels
What class of drug is aspirin and how does it work?
Cyclo-oxygenase inhibitor
Decreases prostaglandin synthesis
Decreases platelet aggregation, antipyretic, anti-inflammatory, analgesic
What treatments can be used if medication fails?
PCI (percutaneous coronary intervention)
CABG (coronary artery bypass graft)
What is the clinical classification for unstable angina?
Cardiac chest pain at rest
Cardiac chest pain with crescendo pattern
New onset angina
