Ischaemic Heart Disease Flashcards
(21 cards)
What % of the vessel needs to be filled to cause flow restriction?
70%
What constitutes primary prevention?
Preventing the risk factors as there are no symptoms due to the atheroma
What constitutes secondary treatment?
There are symptoms and there is active management of these and prevention of a cardiac event
What are the unstable syndromes?
NSTEMI - patient needs to urgently come to hospital
STEMI - medical emergency
How do people die from ischemic heart disease?
50% from sudden death 2/3 rds is the first manifestation
Cardiogenic shock
What is the development to cardiac arrest?
stable plaque- unstable plaque - transient ischemia
acute occlusion - accute MI
chronic closure - scar formation
When there is scar tissue formation due to ischemia this can result in ischemic cardimyopathy, what are the factors which influence whether an abnormal rhythm will develop?
Ischemic burden Hemodynamic fluctuations Autonomic variations Drugs and electrolytes Genetic profile
What is cardiogenic shock?
Inadequate systemic perfusion as a result of cardiac dysfunction
What are some of the causes of cardiogenic shock?
Acute MI
Multivessel disease, particularly occluded LAD (delayed presentation)
Mechanical complications
VSD, MR, Rupture
What is angina?
A clinical diagnosis - chest pain you suspect that their chest pain is cause by myocardial ischemia
What is the purpose of rapid access chest pain clinics?
To make the decision on whether the chest pain they are experiencing is due to vessel occlusion and then to decide upon further investigations
What is needed for a clinical diagnosis of angina?
It is a visceral pain and hard for people to describe and often gestures are used to try to explain
The pain has characteristic patterns of provocation, relief and timing (comes on with exertion and will go away within a minute of stopping)
The patient has a characteristic background - some risk factors
What is the characteristics of the pain being musculoskeletal?
Dull, Knifelike, stabbing Focal, left submammary, in shoulder No pattern, at rest Either fleeting, or prolonged No risk factors
Differential diagnosis of chest pain
GI tract - reflux (burning and provoked by food) - peptic ulcer pain (antacid relief) - oesophageal spasm - eased by GTN spray - Biliary colic Musculoskeletal - injury tender - nerve root pain, character prolonged Pericarditis - central and posture related Pleuitic pain - focal and sharp MI - severe morphine doesn't make it go away PE - breathlessness Aortic dissection - excruciating, severe then eases
What are the pros and cons of exercise testing?
Pros
Cheap
Reproducible
Risk stratification; a positive test at low workload implies poor prognosis
Cons
Poor diagnostic accuracy in important sub-groups - women
Submaximal tests
Pros and cons of perfusion imaging
Pros Non invasive Pharmacological stress in less mobile patients 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 Less precise than angiography, particularly when calcium present Cost
Pros and cons of angiography
Pros “Gold standard” Anatomical and risk stratification Follow-on angioplasty Cons Risk 1:1000 death, stroke Radiation Contrast: renal dysfunction, rash, nausea
What is angiography?
A sheath is inserted into the artery a catheter is advanced from the wrist or groin to the coronary ostium
X-ray contrast agent is injected to outline coronaries and video fluoroscopy will record images in multiple views
What drugs are used in the management of angina and ischemic heart disease?
- Aspirin (antiplatlet)
- B blockers (slow HR, reduce O2 demand)
- Statin (reduces cholesterol)
- ACE inhibitor (reduces blood pressure)
What are the lifestyle changes which should be used in the management of ischemic heart disease?
Stop smoking
Take exercise
Eat a good diet
