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Y2 EMS- Theme 2- Genetic And Environmental Causes Of Disease > 4. Ischaemic Heart Disease And Failure > Flashcards

4. Ischaemic Heart Disease And Failure Flashcards

1
Q

What is Ischaemic heart disease (IHD)

A

Inadequate blood supply to heart

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2
Q

What is IHD caused by

A

Reduced coronary blood flow due to atheroma mostly/ can be thrombus
Myocardial hypertrophy- may be due to high b.p n overworking

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3
Q

What percentage of a coronary vessel lumen being occluded would be considered critical stenosis

A

75 % or more

Therefore have symptoms at this stage

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4
Q

What is door to balloon time

A

The time between getting symptoms to getting a coronary angioplasty of the coronary artery

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5
Q

What is the percentage increase in mortality if the door to balloon time is increased over 2 hrs

A

20 percent to 60 percent

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6
Q

After how long after a coronary occlusion would myocardial necrosis be seen

A

30 minutes

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7
Q

How many minutes is considered rapid perfusion (which would prevent cell loss and can limit infraction size/ area of risk)

A

20 mins

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8
Q

What are the three types of angina pectoris

A

Typical/ stable
Crescendo/ unstable
Variant/ prinzmetal

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9
Q

Which types of angina pectoris can happen at rest

A

Crescendo

Variant/ prinzmetal

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10
Q

How can a typical/ stable angina be relieved

A 
By rest (symptoms occur OE)
Nitrate (vasodilator - cos of chronic narrowing due to atherosclerosis)
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11
Q

What can a crescendo angina be caused by

A

Disruption of the atheromatous plaque eg rupture with partial thrombus/ embolism
- happens usually before MI

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12
Q

What causes variant angina pectoris

A

Due to coronary artery spasm, caused by transient myocardial ischaemia
Unrelated to exertion

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13
Q

What is acute coronary syndrome

A

unstable angina, non-ST-segment-elevation myocardial infarction (NSTEMI) and ST-segment-elevation myocardial infarction (STEMI) that are due to a sudden reduction of blood flow to the heart.

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14
Q

What is ST elevation referring to

A 
Abnormality seen in an ECG 
ST segment (interval between ventricular depolarisation and re polarisation) is raised
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15
Q

What can acute ischaemia lead to

A

Trans mural MI

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16
Q

What is a trans mural MI

A

Ischaemi necrosis involves the full thickness of the ventricular wall

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17
Q

What is a subendocardial MI

A

Ischaemia involved a small area (on the inner layers) of teh myocardial wall not all the layers - only the subendocardium

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18
Q

Which type of MI has ST elevation

A

Trans mural

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19
Q

What does STEMI stand for

A

ST-segment elevation myocardial infarction

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20
Q

What does the heart look like at 1 to 2 days of an MI

A

Pale
Odeamatous
Myocyte necrosis
Neutrophils

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21
Q

What does teh heart look like at 3-4 days of an MI

A

Yellow with haemorrhagic edge
Myoctye necrosis
Macrophages

22
Q

What does the heart look like 1-3 weeks after an MI

A

Red grey to pale- white
Thin
Granulation tissue then fibrosis

23
Q

3 to 6 weeks of an MI, heart looks like?

A

Dense fibrous scar

24
Q

What can cause a subendocardial MI

A

Plaque rupture
Coronary thrombosis where the necrosis doesn’t spread full thickness

Prolonged reduction in systemic blood pressure

25
Q

Hypotensive meaning

A

Abnormally low blood pressure

26
Q

In which people may an MI be silent/ atypical

A

Women
Elderly
Diabetics

27
Q

Tests for MI

A 
ECG 
Cardiac enzymes 
Echo 
Angio
Pulse, breathing
28
Q

What are cardiac enzymes and when can they leak out

A

Blood markers of cardiac myocyte damage that leak out when myocytes become damaged

29
Q

Give 5 examples of cardiac enzymes

A 
Tropnonins T and I
Creatine kinase MB
Myoglobin 
Lactate dehydrogenase isoenzmye 1
Aspartate trasnaminase
30
Q

Why might the cardiac enzyme aspartate transaminase be a less useful marker of myocardial damage

A

It is also present in the liver

31
Q

What do troponins T and I do

A

Regulate Ca mediated contraction

Tissue specific

32
Q

When are levels of troponins T and I raised

A

Post MI
PE
Heart failure
Myocarditis

33
Q

What else apart from teh heart is myoglobin also released from

A

Damaged skeletal muscle

34
Q

Treatment of MI

A 
MONA=
Morphine 
Oxygen 
Nitrates
Aspirin 
Reperfusion (eg, PCI, balloon angioplasty, stenting, coronary artery bypass grafting)
35
Q

What that is the main aim of the treatment given for an MI

A

Reduce total ischamic time

36
Q

What treatment can be given as a secondary prevention for MI

A

Ace- I = help to dilate vessel
Anti platelets = stops platelets from sticking - reduce clot formation
Anticogaltion = slow process of clot formation
Antiarrhythmics= restore normal heart rhythm
Beta blockers = reduce activity of the heart
Statins = lower blood choesltrol levels

37
Q

What % of MIs are fatal

A

Over 35%

38
Q

What % of fatal cardiac deaths are sudden cardiac deaths (in 1 to 2 hrs)

A

70%

39
Q

Who may be at more risk of MI

A

Women
Elderly
Diabetics
Had a previous MI

40
Q

How can an MI cause a myocardial rupture

A

Due to weakening of the necrotic muscle

41
Q

What is tamponade

A

Compression of the heart by an accumulation of fluid in the pericardial sac

42
Q

What is an aneurysm

A

Excessive localised swelling of an artery wall

43
Q

What is chronic IHD

A

Progressive heart failure due to ischaemic myocardial damage

44
Q

What is familial hypercholestrolaemia

A

Mutations in genes involved in cholesterol metabolism:

  • low density lipoprotein receptor gene
  • apoliprotein B
45
Q

Symptoms of familial hyper cholesterolaemia in heterozygotes and thier treatment

A

Xanthomas = yellow patch/ nodule on skin caused by lipid deposition
Periocular corneal arcus
Early progressive atherosclerosis
Treatment = statins (hydroxymethyl CoA reductase inhibtors)

46
Q

What is heart failure

A

Heart is unable to pump blood at required demand

End stage of all disease of the heart

47
Q

In the western world what are the two most common causes of HF

A

Coronary artery disease (CAD)

Hypertension

48
Q

Symptoms/ signs of HF

A 
Dilated pupils 
Infarct 
Low bp
Weak pulse
Pitting oedema 
Confusion 
Falling 02 saturation 
Cough 
Dyspnea 
Orthopnea etc.
49
Q

Give some causes of HF

A

CAD
Hypertension
Alcohol and drugs
Cardiomyopathy etc.

50
Q

Investigation for HF

A 
Initial:
CXR
ECG
Echo 
Bloods
51
Q

What does the New York Classifaction of heart failure severity do

A

Tells us about survival probability
Four classes:

I= no symptoms, normal functional status 
II= mild symptoms with normal activity, comfy at rest, slight limit of functionality 
III= moderate symptoms 
IV= sever symptoms even at rest, sever limitation of functional status

Y2 EMS- Theme 2- Genetic And Environmental Causes Of Disease (7 decks)

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