8 - Ischaemic Heart Disease

Question 1

If infarct patterns are present in leads I, V5, V6 and aVL, what area of the heart has the infarct occurred in and which artery supplies it?

Answer 1

Lateral heart damage

Supplied by left circumflex artery

Question 2

If infarct patterns are present in leads II, III and aVF,what area of the heart has infarction occurred in and which artery supplies it?

Answer 2

Inferior heart damage

Supplied by right coronary artery

Question 3

If infarct patterns are present in leads V1 and V2, what area of the heart has the infarction occurred in and which coronary artery supplies it?

Answer 3

Septal area of heart

Supplied by left anterior descending artery

Question 4

If infarct patterns are present in leads V3 and V4, what area of the heart has the infarct occurred in and what artery supplies it?

Answer 4

Anterior heart damage

Supplied by right coronary artery

Question 5

Define ischaemic heart disease

Answer 5

Chest pain secondary to pathology involving the heart that affects its blood supply

Question 6

What are the modifiable risk factors for ischaemic heart disease?

Answer 6

Smoking
Hypertension 
Diabetes 
Obesity 
Sedentary lifestyle 
Hypercholesterolaemia

Question 7

What are the non modifiable risk factors for ischaemic heart disease?

Answer 7

Old age
Family history
Male

Question 8

When does ischaemic heart disease occur?

Answer 8

When the metabolic demands of the cardiac muscle are greater than what can be delivered by the coronary arteries, e.g. When atherosclerosis reduces blood flow through the coronary arteries

Question 9

What are acute coronary syndromes?

Answer 9

Acute myocardial ischaemia caused by atherosclerotic coronary artery disease on a spectrum of acute increasing occlusion

Question 10

Name the acute coronary syndromes

Answer 10

Unstable angina
Myocardial infarction
NSTEMI
STEMI

Question 11

Describe the pathology that leads to acute coronary syndromes

Answer 11

Atherosclerotic plaque forms
Atherosclerotic plaque ruptures
Platelets aggregate and form a thrombus that is partially occlusive, can progress to be fully occlusive

Question 12

What is the different between cardiac tissue ischaemia and infarction?

Answer 12

Infarction - cardiac enzymes leak from necrosed muscle tissue
Ischaemia - no enzyme leakage

Question 13

Describe the typical history for lung/heart pain

Answer 13

Visceral
Dull
Poorly localised pain
Worse with exertion

Question 14

Describe the typical history of pleural/ pericardial sac pain

Answer 14

Somatic
Sharp
Localised pain
Worse with inspiration, coughing and positional movement

Question 15

Describe the typical history of pericarditis, including ECG

Answer 15

Sharp 
Localised pain to front of chest 
Worse with inspiration, coughing and lying flat
Pericardial rub heard on auscultation 
ECG - wide concave ST elevation

Question 16

Describe the typical history for stable angina

Answer 16

Dull retrosternal pain, can radiate up to neck
Triggered by exertion
Relieved by rest

Question 17

How is stable angina treated?

Answer 17

GTN spray under tongue during episodes
Beta blockers 
ACE inhibitors 
Statins
Calcium channel blocker 
Surgery - coronary artery bypass or angioplasty

Question 18

What is the difference in histories between stable and unstable angina?

Answer 18

Unstable angina:
Intense pain
Longer lasting pain
Pain occurs at rest
ECG pattern shows NSTEMI pattern

Question 19

Describe the typical history for a myocardial infarction

Answer 19

Dull retrosternal crushing pain
Pain radiates to left arm and left side of the jaw
No relieving factors
Sweating, pallor and nausea (Increased sympathetic output)

Question 20

What tests would you carry out if you suspected an MI and what would they show if you are right?

Answer 20

Blood test for cardiac markers such as troponin c that indicate cardiac myocyte death
ECG - will show ST elevation and Q waves for a STEMI, ST depression or T wave inversion for NSTEMI

Question 21

How would you treat a confirmed myocardial infarction?

Answer 21

Oxygen
Pain relief
GTN sublingually
Antiplatlets

Question 22

What are the differences between a STEMI and an NSTEMI?

Answer 22

STEMI - caused by acute total occlusion of coronary artery
ECG shows ST elevation and q waves
NSTEMI - caused by acutely progressive tight stenosis of a coronary artery

Question 23

How does blood flow into the coronary arteries?

Answer 23

When the heart is relaxed, back flow of blood flows into the aortic sinuses (behind aortic valve) into the coronary arteries