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Cardiovascular System > Lecture 10 - Ischaemic Heart Disease > Flashcards

Lecture 10 - Ischaemic Heart Disease Flashcards

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1
Q

What are causes of chest pain in the lungs and pleura?

A

Pneumonia
Pulmonary embolism
Pneumothorax

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2
Q

What are causes of chest pain in the GI system?

A

Oesophagus - reflux
Peptic ulcer disease
Gall bladder - biliary colic, cholecystitis

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3
Q

What are the causes of chest pain in the chest wall?

A

Ribs
Muscle
Skin

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4
Q

What are the causes of chest pain in the CVS?

A

Myocardium - angina, MI
Pericardium - pericarditis
Aorta - aortic dissection

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5
Q

What are the 3 non modifiable risks for coronary atheroma?

A

Increasing age
Male gender
Family history

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6
Q

What are the 8 modifiable risks for coronary atheroma?

A 
Hyperlipidaemia
Smoking
Hypertension
Diabetes mellitus
Exercise
Obesity
Stress
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7
Q

Where is the chest pain from IHD?

A

Central, retrosternal or left sided.

May radiate to shoulders, arms, neck, jaw, and back.

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8
Q

What sort of pain comes from IHD?

A

Tightening, heavy, crushing, constricting, pressure.

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9
Q

What sort of pain could come from an inferior MI?

A

Burning epigastric (like heartburn/indigestion)

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10
Q

How do the symptoms of IHD get progressively worse?

A

Stable angina –> unstable angina –> MI

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11
Q

What is stable angina?

A

Atheromatous plaques with necrotic centre and fibrous cap build up in coronary vessels occluding the lumen. Leads to ischaemia of myocardium.

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12
Q

How much of the lumen is occluded in angina?

A

> 70%

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13
Q

What is the chest pain in stable angina?

A

Typical ischaemic chest pain.
Brought on in brief episodes by exertion, stress and cold weather.
Mild to moderate.

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14
Q

How are acute episodes of angina treated?

A

Sub lingual nitrate spray

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15
Q

How are angina episodes prevented?

A

B blockers, Ca channel blockers, oral nitrates

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16
Q

How are cardiac events prevented in angina?

A

Aspirin, statins, ACE inhibitors

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17
Q

How is angina treated long term?

A

Revascularisation

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18
Q

What is unstable angina?

A

Progression from stable angina due to increased occlusion

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19
Q

What is the chest pain in unstable angina?

A

Ischaemic chest pain occurring at rest or on minimal exertion.
Severe and occurs with a crescendo pattern.

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20
Q

What is an MI?

A

Complete occlusion of a coronary vessel leading to an infarct of the myocardium it supplies

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21
Q

What happens in an MI?

A

The fibrous cap of the plaque is eroded, exposing the blood to the thrombogenic material in the core - platelet clot is followed by a fibrin thrombus to occlude the vessel or break off to form an embolism

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22
Q

What is the chest pain in an MI?

A

Typical ischaemic chest pain.

Severe and persistent at rest, no relief from rest or nitrate spray.

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23
Q

What are the symptoms of an MI?

A 
Chest pain
Breathlessness
Faint
Anxiety
Sweating
Pallor
Nausea
Vomiting
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24
Q

What is an NSTEMI?

A

Non ST elevated MI

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25
What is the significance of an NSTEMI?
Infarct is not full thickness of myocardium
26
What is a STEMI?
ST elevated MI
27
Whar is the significance of a STEMI?
Infarct is full thickness of myocardium
28
What would the resting ECG show in angina?
Normal
29
What is the exercise stress test graded on?
Heart rate Chest pain ECG changes Other problems
30
What is shown in a positive exercise stress test?
ST depression of >1mm
31
What is acute coronary syndrome?
Group of symptoms attributed to obstruction of coronary arteries
32
What is acute coronary syndrome a result of?
Unstable angina, STEMI and NSTEMI
33
What level is the occlusion by thrombus in unstable angina?
Partial
34
What level is the occlusion by thrombus in NSTEMI?
Partial
35
What level is the occlusion by thrombus in STEMI?
Total
36
What level is the myocardial necrosis in unstable angina?
None
37
What level is the myocardial necrosis in NSTEMI?
Some
38
What level is the myocardial necrosis in STEMI?
Large myocardial infarct
39
What is the effect on ECG in unstable angina?
May have ST depression, T wave inversion or normal
40
What is the effect on ECG in NSTEMI?
No ST elevation
41
What is the effect on ECG in STEMI?
ST elevation
42
What is the biochemical marker in the blood in STEMI and NSTEMI?
Troponin
43
What is the ECG change minutes-hours after an MI?
ST elevation, T wave upright
44
What is the ECG change hours-day 1/2 after an MI?
ST elevation, decreased T wave, decreased R wave, Q wave begins
45
What is the ECG change days 1-2 after an MI?
Q wave deeper
46
What is the ECG change days after an MI?
ST normalises, T wave inverted, Q wave persists
47
What is the ECG change weeks after an MI?
ST and T normal, Q wave persists
48
Which ECG leads would show an inferior infarction?
II, III, aVF
49
Which artery would lead to an inferior infarction?
Right coronary
50
Which ECG leads would show an antero septal infarction?
V1, V2
51
Which artery would lead to an antero septal infarction?
Left anterior descending
52
Which ECG leads would show an antero apical infarction?
V3, V4
53
Which artery would lead to an antero apical infarction?
Left anterior descending (distal)
54
Which ECG leads would show an antero lateral infarction?
I, aVL, V5, V6
55
Which artery would lead to an antero lateral infarction?
Circumflex
56
Which ECG leads would show an extensive anterior infarction?
I, aVL, V2, V3, V4, V5, V6
57
Which artery would lead to an extensive anterior infarction?
Proximal left coronary
58
Which ECG leads would show a true posterior infarction?
Tall R in V1
59
Which artery would lead to a true posterior infarction?
Right coronary
60
When do troponin levels rise after an MI?
Rise 3-4 hours after Peak 18-36 hours Decline slowly for 10-14 days
61
When do creatine kinase levels rise after an MI?
Rise 3-8 hours after Peak 24 hours Return to normal 48-72 hours after Specific isoenzyme for myocardium
62
How are biochemical markers used?
Distinguishes between unstable angina and NSTEMI - no myocardium death in unstable angina
63
How is unstable angina treated?
Preventing it from progressing to MI by: Preventing progression of thrombosis Restoring perfusion of partially occluded vessels
64
How is the progression of thrombosis prevented?
Anti thrombotic therapy - antiplatelets (aspirin) and anticoagulants (heparin)
65
How is perfusion restored in partially occluded vessels in high risk patients?
Angioplasty/percutaneous coronary intervention | Coronary artery bypass graft
66
How is perfusion restored in partially occluded vessels in low risk patients?
Medical treatment
67
How is perfusion restored in partially occluded vessels in general?
``` Pain control Oxygen Organic nitrates B blockers Statins ACE inhibitors ```
68
How is angioplasty used?
To view any vessel occlusions
69
How is pecutaneous coronary intervention used?
Angioplasty and stenting - inflation of a balloon inside the vessel expands a mesh to hold the vessel open
70
How is coronary bypass (CBPG) grafting used?
Take an artery from somewhere else in the body and graft it to the heart
71
Which vessels can be used for CBPG?
Internal mammary artery Radial artery Saphenous vein
72
What has to be done to the saphenous vein for CBPG?
Reversed because of the valves
73
What can cause acute pericarditis?
``` Infection Post MI/cardiac surgery Autoimmune Uraemia (kidney failure) Malignant deposits ```
74
What are the symptoms of acute pericarditis?
Central/left sided chest pain Sharp, worse on inspiration Improved by leaning forward

Cardiovascular System (15 decks)

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