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Flashcards in Session 10 Deck (35)
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1

How can the lungs and pleura cause chest pain?

Pneumonia
Pulmonary embolism
Pneumothorax

2

How can the GI system cause chest pain?

Oesophagus reflux
Peptic ulcer disease
Cholecystitis

3

How can the chest wall cause chest pain?

Fractures to the ribs
Muscles
Skin

4

How can the CVS cause chest pain?

Myocardium - angina MI
Pericarditis
Aortic dissection

5

What are the non modifiable risk factors for coronary atheroma

Age
Sex (male worse)
Family history

6

What are the modifiable risk factors for coronary atheroma?

Hyperlipidaemia
Smoking
Hypertension
Diabetes mellitus
Obesity
Exercise
Stress

7

How do you get ischaemia of the myocardium in stable angina?

Atheromatous plaques, with a necrotic centre and fibrous cap build up in the coronary vessels and partially occlude them

8

When do you get chest pain in stable angina?

Upon exercise
Cold
Stress

9

How can you treat angina?

Nitrate sprays (Acute)
Beta blockers/Ca2+ channel blockers (prevent)
Aspirin, statins, ACEi (prevent cardiac episodes)
Revascularisation (long term)

10

What is unstable angina?

Pain on rest due to increased occlusion of the arteries

11

What is a myocardial infarction?

Complete occlusion of a coronary artery which leads to loss of oxygen and death of the myocardium

12

How can the atheromatous plaque cause an embolism to form?

The fibrous cap can undergo fissuring or erosion which exposes the blood to the thombogenic material in the necrotic core. A fibrin thrombus follows a platelet clot.

13

What is the difference between an NSTEMI and STEMI?

NSTEMI - Non elevated ST interval. Infarct is not full thickness of the myocardium
STEMI - Elevated ST interval. Infarct is full thickness of the myocardium

14

How can you diagnose angina?

Mainly based on the patient history
May have some of the associated risk factors
Exercise test - graded exercise until chest pain, target HR reached, ECG change, arrhythmia issues

15

What does an ECG positive for angina show?

An ST depression bigger than 1mm

16

What can cause Acute Coronary Syndrome?

Unstable angina
STEMI
NSTEMI

17

How can you differentiate between unstable angina and a STEMI/NSTEMI?

T waves may be inverted in unstable angina
NSTEMI/STEMI would have Troponin in the blood as a biochemical marker

18

Which leads would pick up on an infarct in the Right coronary artery? (inferior)

II, III, aVF

19

Which leads would pick up on an infarct in the Left anterior descending? (Anterio septal)

V1, V2

20

Which leads would pick up on an infarct in the distal section of left anterior descending? (antero apical)

V3, V4

21

Which leads would pick up on an infarct in the circumflex artery? (antero lateral)

I, aVL, V5, V6

22

Which leads would pick up on an infarct in the proximal left circumflex artery? (extensive anterior)

I, aVL, V2 - V6

23

Which leads would pick up on an infarct in the right coronary artery? (true posterior)

Tall R wave in V1

24

How are Troponins used to indicate a STEMI/NSTEMI?

Cardiac troponin I and troponin T are important in myosin and actin interaction. They are released on the muscle cells death

25

What is the cardiac isoenzyme of creatinine kinase?

CK-MB

26

How can CK-MB and Troponins in the blood help differentiate between unstable angina and NSTEMI?

Shows there has been death of the myocardium which only occurs in an NSTEMI

27

What is the goal when treating unstable angina/MI?

Prevent progression to MI
Save muscle mass in an MI

28

What can be given as part of anti thrombotic therapy?

Anti platelet agents - Aspirin
Anticoagulants - Heparin

29

How can you restore perfusion to partially occluded vessels in high risk patients?

Early Percutaneous Coronary Intervention (Angioplasty) (PCI)
Coronary Artery Bypass Graft (CABG)

30

How can you restore perfusion to partially occluded vessels in low risk patients?

Medications