2- coronary heart disease overview Flashcards
what familial trait identifies with sudden ischaemic heart disease death?
long QT interval - associated with sudden cardiac death in ischaemic heart disease
what is cardiogenic shock?
- inadequate systemic perfusion as a result of cardiac dysfunction
- if untreated = 90% chance mortality
what can cause cardiogenic shock?
- acute MI = multivessel disease, particularly occluded LAD
- mechanical complications like VSD (ventricular septal defect), MR (mitral regurgitation), rupture (of muscle)
what is type 2 MI?
- associated with death - NOT caused by acute event in coronary arteries like atherosclerotic plaque
- associated with lack of oxygen
- elevated troponin is associated with lack of O2, release during another illness - no evidence of recent plaque rupture
- symptoms of MI, abnormal ECG
- if only troponin then myocardial injury
- risks relate to their other condition
what is troponin?
group of proteins found in skeletal and cardiac muscle fibers
(calciumis released and binds to troponin, a regulatory protein associated with actin. This binding causes a conformational change in troponin, which exposes binding sites on actin for myosin
is angina a clinical diagnosis?
yes
how can tests help coronary disease?
tests can suggest or confirm the presence of coronary disease
can people have coronary disease without angina?
yes
what can make clinical diagnosis of angina?
visceral pain from myocardial hypoxia = hard to described, often use gestures (pressing, squeezing, heaviness, weight, radiating)
characteristic patterns = provocation (exertion, stress, cold, after meals) , relief (by rest) & timing (only a few mins)
characteristic background = age, gender, smoking etc
what are different diagnosis of chest pain?
- GI tract
- musculoskeletal
- pericarditis
- pleuritic pain
what is GI tract differential diagnosis of chest pain?
- reflux, burning, acid, waterbrush, provoked by food
- peptic ulcer pain - epigastric, boring, point of finger gesture, relief by antacids/food
- oesophageal spasm
- biliary colic
what is musculoskeletal differential diagnosis of chest pain?
- injury - location, tender, prolonged, exacerbates by moving area
- nerve root pain, character, prolonged
what is pericarditis differential diagnosis of chest pain?
- central - posture related (relieved by sitting forward)
what is pleuritic pain differential diagnosis of chest pain?
focal - exacerbated by breathing, sharp, catching
what would be clinical presentation of MI?
- severe, associated autonomic upset
- ongoing pain, despite >10mg morphine
what would clinical presentation of pulmonary embolism?
breathlessness, dull (maybe pleuritic)
what is the main thing that helps you diagnose angina?
the history - tests help you rule in or rule out
what is presentation of dissection of aorta?
tearing, excruciating, severe then eases
when is risk stratification tests less helpful?
- high risk (risk of false negative result)
- low risk (risk of false positive result)
what are the pros of exercise testing?
cheap, reproducible, risk stratification (positive test at low workload implies poor prognosis)
what is risk stratification?
the process of categorizing individuals or populations based on their likelihood or risk of developing a particular health condition, experiencing specific events, or responding to certain treatments
is risk stratification good or bad for testing?
good = valuable because it allows healthcare providers to distinguish individuals based on their health risks. This process helps in identifying those who may be at a higher risk of developing specific health conditions or experiencing adverse outcomes
what are cons of exercise testing?
poor diagnostic accuracy in important sub groups (female), submaximal tests (exercise or physiological tests that do not require an individual to exert maximum effort)
what is perfusion imaging?
imaging that provides info about blood flow to tissues & organs
