10. Chest Pain and IHD Flashcards
Name 3 pulmonary causes of chest pain
Pneumonia
Pulmonary embolism
Pneumothorax
Name 3 non modifiable risk increasing factors for coronary atheroma
Age
Male
Family history
Name 4 important modifiable risk factors for atheroma
Hyperlipidaemia
Smoking
Hypertension
Diabetes mellitus
What does an atheromatous plaque consist of?
Necrotic centre and a fibrous cap
What is the treatment for acute episodes of stable angina?
Sublingual GTN spray
What is the difference in the atheromatous plaque in unstable angina?
Thinner fibrous cap so a thrombus formation is more likely to randomly occur
What is the difference in terms of the infarct between a STEMI and an NSTEMI?
In a STEMI the infarct is the full thickness of the myocardium
What can an ECG for unstable angina look like?
ST depression
T wave inversion
Normal
How can you differentiate between an NSTEMI and unstable angina if e ECG looks normal?
The presence of biochemical markers would indicate an NSTEMI in this case
How much myocardial necrosis is there in unstable angina?
None
How much myocardial necrosis is there in an NSTEMI?
Some
How much myocardial necrosis is there in a STEMI?
Large infarct
A patient has high levels of troponin I in there blood, how do you differentiate between a STEMI and an NSTEMI?
An ECG, a STEMI will have ST elevation, an NSTEMI will not
What feature of a STEMI ECG will become more apparent as time goes by?
Pathological Q wave
Hours and days after the MI, what will happen to the ST elevation?
Becomes less elevated, T wave then inverts then returns to normal weeks later
At what time does troponin peak?
18-36 hours after MI
What time does troponin begin to rise?
3-4 hours after onset
What is CK-MB?
The cardiac isoenzyme of creatine kinase
When does creatine kinase peak and then return to normal?
Peak at 24 hours
Return to normal within 72 hours
Why might you use creatine kinase over troponin when telling if a patient has had an MI?
If they have had a recent MI, troponin will remain for 14 days but CKMB will return to normal within 72 hours
It is therefore easier to tell if a second MI has occurred within this timeframe using CKMB
What drugs can be used to prevent thrombus formation?
Anti platelet - aspirin
Anti coagulant - heparin
What is an angiography?
Injecting an x Ray absorbing dye to view any vessel occlusions
What is PCI (percutaneous coronary intervention)?
Angioplasty and stenting
Inflation of a balloon inside the occluded vessel expands a mesh that holds the vessel open
What is a coronary bypass graft?
Using a vessel from elsewhere e.g. Internal mammary artery, radial artery or a saphenous vein put in reversed to graft onto the heart
Name 3 cardiovascular causes of chest pain
Myocardial ischaemia - (tightening pain)
Pericarditis - (sharp pain)
Aortic dissection - (tearing pain)
