8 Cardiovascular (Ischaemic Heart Disease) Therapeutics Flashcards
Define and describe Ischaemic Heart Disease
Vascular supply of Heart to the heart is impeded by atheroma, thrombosis or spasm of the coronary arteries
The resultant myocardial infarction occurs when oxygen demand exceeds myocardial oxygen supply
- Pain can be induced, but sometimes the ischaemia is ‘silent’
(e. g. in people with diabetes mellitus)
List some risk factors of Ischaemic Heart Disease
- Smoking
- Raised Serum Cholesterol
- Hypertension
- Diabetes
- Stress
- Obesity
- Male
Describe the prevalence of Ischaemic Heart Disease
- CHD levels lower in groups with higher incomes
- CHD deaths have fallen in this group since the 1970s (linked to a reduction in fat consumption/smoking)
- 3 million people in the Uk have had a myocardial infarction
- and 2 million have Ischaemic Heart Disease
Describe atherosclerosis, and the relation with CVD
IHD occurs when atherosclerosis occurs in the coronary arteries (starts to occur before adulthood)
- Atherosclerosis occurs in coronary arteries
- Fatty streaks contain LDL cholesterol, macrophages, T cells
The proliferation of smooth muscle cells into the inner coating of artery and build-up of collagen, glycoproteins leads to the formation of a fibrous cap surrounding cells leading to plaque formation
Describe plaque attack, and how this plaque can lead to ACS
Plaques reduce blood flow
- Coronary arteries get stiffer and have less dilation - less blood flow (ischaemia)
- The plaque can rupture, leading to a loss of endothelium
- This leads to a formation of a thrombus
Formation of ACS
(acute coronary syndrome)
Describe chest pain, and how it can present, and be caused
Chest pain can present in similar ways, and maybe caused by different things:
- Angina pectoris
- Variant angina (prinzmetals)
- GORD/oesophageal spasm
- Hypertrophic cardiomyopathy
- Pulmonary embolus
- Costochondritis
- Myocardial infarction
- Mitral valve prolapse
- Pneumonia/Lung cancer
Give the relation between chest pain and angina
and how it can be a concern for angina, ACS, and MIs
NICE guidelines:
- NICE considers those patients who present with acute, new-onset chest pain and those who present with intermittent, stable chest pain (develops chest pain after exercise)
There is a major concern that the pain may be due to Acute Coronary Syndrome (ACS), which includes conditions such as:
- Unstable Angina
- ST-segment-elevation MI (STEMI)
- Non-STEMI (NSTEMI)
Describe some symptoms of Acute Coronary Syndrome
- New-onset chest pain
- OR abrupt deterioration in previously stable angina, with recurrent chest pain occurring with little or no exertion. Episodes last > 15mins
- Pain in chest and other areas such as arms, back and jaw lasting longer than 15 mins
- Chest pain is associated with nausea and vomiting, breathlessness, marked sweating
Describe when/how to refer to the hospital if suspected of ACS
Send to hospital for suspected ACS
- currently have chest pain
- currently pain-free, but had chest pain in the last 12 hours, and a resting 12-lead ECG is abnormal
A normal ECG DOES NOT EXCLUDE ACS if other clinical features are present
Describe what to be aware of when taking a clinical history of a patient suspected of ACS/IHD
PMH - e.g. history of angina, MI, CVD and PCI (percutaneous coronary intervention)
- Risk factors for cardiac disease
- Pain history e.g. longer than 15mins
- Chest pain may not be the main presenting symptom (e.g. may present with mainly breathlessness)
> Diabetes can have damaged cardiac nerve endings
> Do not use response to GTN (glycerol Trinitrate) to diagnose whether pain is cardiac or not
Describe what to do if ACS is suspected (emergency)
ACS ASAP!
- Emergency admission
- Relieve pain with GTN (glycerol trinitrate) and/or opioid
- Aspirin 300mg unless allergic (then give clopidogrel)
- Carry out an ECG, and send to the hospital
- Measure O2 sats (give O2 if Sats <94%)
Describe a stable angina
and what is done to manage it
Some having a current angina
- they can undergo a PCI, where a stent is inserted
If it is an ongoing/chronic angina (MI)
- CABG (coronary artery bypass graft)
Describe factors affecting stable angina
(what can relieve it)
(imaging that can be used)
- Stable angina can be provoked by numerous factors including cold weather, exertion, eating a heavy meal, or stress
Angina attack can be relieved by Glyceryl Trinitrate (GTN)
Coronary Angiography is a procedure that uses contrast dye and X-ray pictures to detect blockages in the coronary arteries that are caused by plaque build-up
Describe Prinzmetal’s (Variant) Angina
- Achy, dull, tight, pressy pain
- Can occur at rest or at night
- Mainly in younger women
- Spasm of coronary artery
- Relieved by GTN
- ECG during attack must be done
- CCB’s first line (calcium channel blockers)
Describe the treatment for an angina attack
GTN - glycerol trinitrate - treatment for angina
- Relieves load on the heart
It is sprayed on the tongue
- as GTN has high 1st pass metabolism, so this way it can bypass the liver and enters the bloodstream directly