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CVD > 7. Ischaemic Heart Disease > Flashcards

7. Ischaemic Heart Disease Flashcards

1
Q

What increases the oxygen demand of the myocardium?

A

Rate
Contractability
Tension

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2
Q

What affects the oxygen supply to the myocardium?

A

Oxygenated blood

Coronary artery flow

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3
Q

What part of the heart is supplied by the left anterior descending artery?

A

Anterior wall of LV
Apex
Anterior 2/3 of the septum

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4
Q

What part of the heart is supplied by the right coronary artery?

A

Posterior wall

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5
Q

Name the forms of ischaemic heart disease

A

Angina
MI
Chronic ischaemic heart disease

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6
Q

What is stable angina?

A

Chest pain brought on by exercise and relieved by rest

75% occlusion of one of main coronary arteries

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7
Q

How is stable angina assessed?

A

Angiography

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8
Q

What conditions worsen stable angina?

A

Anaemia

Hypertrophy

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9
Q

What is unstable angina?

A

Stable angina that has recently progressed
The atherosclerotic plaque has been disrupted and caused a thrombus
High risk of acute MI

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10
Q

What are the causes of sudden cardiac death?

A

Thrombosis
Arrhythmia
Spasm in cocaine use

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11
Q

What is an MI?

A

Necrosis of the myocardium due to decreased blood supply

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12
Q

What is the clinical presentation of an MI?

A

Crushing central chest pain

Weakness, nausea, sweating, vomiting

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13
Q

What is the pathology of an MI?

A

Plaque rupture and thrombosis causes ischaemia

Begins subendocardium as that is furthest from blood supply

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14
Q

What is used to diagnose MI?

A

ECG
Troponin
Creatine kinase

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15
Q

What is troponin?

A

regulatory proteins of actin filaments in cardiac muscle

Released in any damage to heart, chemo, renal disease

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16
Q

How long does it take for changes to be seen in the myocardium after an infarction?

A

10 hours

17
Q

What changes are seen in the myocardium after 1 day?

A

Coagulation necrosis
Hypereosinophila and wavy fibres (due to oedema)
Macroscopically heart is dark, red and firm

18
Q

What happens to the myocardium 2-7 days after an MI?

A

Signs of inflammation in nearby tissue: neutrophils and oedema
Patient might have high WCC and fever
Macroscopically tissue is soft and yellow

19
Q

What happens to the myocardium on days 7-14?

A

Dead tissue is resorbed and granulation tissue at edges

Macroscopically depressed area with red edges

20
Q

What happens to the myocardium on weeks 2-8?

A

Fibrosis and increased vascularity

Macroscopically tissue is grey/white

21
Q

How does the myocardium appear 8 weeks after an MI?

A

Dense fibrosis

Macroscopically a depressed thinned myocardium with a scar

22
Q

What are rare causes of coronary artery occlusion?

A

Vasculitis
Thrombus due to hypercoaguability
Trauma causing coronary dissection
Vasospasm

23
Q

What are the causes of sudden death in MI?

A 
Ventricular fibrillation (especially with posterior inferior MI)
Cardiac tamponade
24
Q

What complications are associated with MI?

A 
Arrhythmias within 48 hours
LV failure and pulmonary oedema
Cardiogenic shock
Ventricular rupture and haemopericardium
Chordae tendinae or papillary muscle rupture
LV aneurysm formation
Pericarditis and Dressler's syndrome
25
Q

What finding would be present in LV aneurysm formation?

A

2 apex beats

26
Q

What results from rupture through the ventricular wall post MI?

A

Haemopericardium and cardiac tamponade

27
Q

What results from rupture through the septum post MI?

A

Ventricular septal defect

28
Q

What results from rupture of the papillary muscle post MI?

A

Valve dysfunction and valve failure

29
Q

What are the signs of mild LV failure?

A

Sinus tachycardia

30
Q

What are the signs of moderate LV failure?

A

Dyspnoea and evidence of pulmonary oedema

31
Q

What are the signs of severe LV failure?

A

Cardiogenic shock
Hypotension
Poor tissue perfusion
Reduced ejection fraction on ECHO

32
Q

What type of MI is associated with pump problems?

A

Anterior MI

33
Q

What type of MI is associated with conduction problems?

A

Posterior MI

34
Q

What conditions are under the term chronic ischaemic heart disease?

A

Angina and progressive heart failure

35
Q

What can be seen in chronic ischaemic heart disease?

A

Hypertrophy
Dilation
Narrow CA
Myocardial fibrosis

36
Q

What drug is used for the primary prevention of chronic ischaemic heart disease?

A

Statins

37
Q

What interventions are used to treat a STEMI?

A

Percutaenous coronary intervention

Thrombolysis

CVD (22 decks)

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