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TCA 1 - Chest Pain > Angina and Coronary Artery Disease > Flashcards

Angina and Coronary Artery Disease Flashcards

1
Q

What is angina?

A

Symptomatic, reversible myocardial ischaemia

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2
Q

What are the symptoms of angina?

A
  • Constricting / Heavy discomfort in chest, jaw, neck, shoulders or arms
  • Symptoms brought on by exertion
  • Symptoms relieved by rest or GTN within 5 minutes
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3
Q

What is the difference between typical angina, atypical angina and non-anginal chest pain?

A

Typical Angina
- all 3 symptoms

Atypical Angina
- 2 symptoms

Non-anginal Chest Pain
- 1 symptom

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4
Q

What is the management of angina?

A
  • GTN spray

- Beta-blockers and/or Calcium channel blocker

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5
Q

What is the advice for a further angina attack?

A
  1. Stop what you are doing and rest
  2. Use GTN
  3. Take 2nd dose of GTN after 5 mins if pain has not eased
  4. Call 999 if pain has not eased after anther 5 mins (15 mins in total) or if pain intensifies/feel unwell
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6
Q

What are the risk factors of coronary artery disease?

A
  • Age
  • Male gender
  • Hyperlipidaemia
  • Diabetes
  • Smoking
  • Hypertension
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7
Q

What parts of the patient history are relevant to diagnosing CAD?

A
  1. Con-current diagnosis of CAD
    - Stable angina, previous MI etc.
  2. Con-current diagnosis of atherosclerotic atrial disease
    - Ischaemic stroke, peripheral vascular disease or renovascular disease
  3. Family Hx of coronary artery or atherosclerotic arterial disease
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8
Q

What would show up on a chest examination?

A

Heart murmurs

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9
Q

How are heart murmurs transmitted?

A

Blood flow remains turbulent after it passes through structural defect, so the murmur will continue to be heard in the direction that turbulent blood is flowing

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10
Q

What is the S1 sound?

A

First heart sound

  • Caused by closure of mitral and tricuspid valves
  • Start of systole in ventricles
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11
Q

What is the S2 sound?

A

Second heart sound

  • Caused by closure of aortic and pulmonary valves
  • End of systole and start of diastole
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12
Q

What is the S3 sound?

A

Third heart sound

- Caused by diastolic filling of the ventricle

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13
Q

What is the S4 sound?

A

Fourth heart sound

  • Caused by atrial contraction against a stiff ventricle
  • coincides with P-wave on ECG
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14
Q

When is S3 heard?

A

Left ventricular failure
Constrictive pericarditis
Mitral regurgitation

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15
Q

When is S4 heard?

A

Aortic stenosis
HOCM
Hypertension

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16
Q

What murmurs are heard in systole?

A

Aortic and pulmonary stenosis
Mitral and tricuspid regurgitation
Mitral valve prolapse

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17
Q

What murmurs are heard in early diastole?

A

Aortic and pulmonary regurgitation

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18
Q

What murmurs are herd in mid-late diastole?

A

Mitral and tricuspid stenosis

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19
Q

When do you auscultate with the bell and diaphragm?

A

Bell
- Low pitched sounds

Diaphragm
- High pitched sounds

20
Q

Where do you auscultate heart sounds?

A

Aortic - second right intercostal space (ICS), right sternal border

Pulmonary - second left intercostal space (ICS), left sternal border

Tricuspid - Fourth left ICS, left sternal border

Mitral/Apex - Fifth ICS, left mid-clavicular line

21
Q

What is an ejection murmur?

A

Due to turbulent forward flow through narrowed or irregular valves or outflow tracts

22
Q

What is a regurgitant murmur?

A

Represent retrograde or abnormal flow into chambers that are at lower resistance.

23
Q

Give an example of a ejection murmur

A

Aortic stenosis

Pulmonary Stenosis

24
Q

Give an example of a regurgitant murmur

A

Mitral regurgitation
Tricuspid regurgitation
Ventricular septal defects

25
Q

Aortic Stenosis

  1. Heart cycle
  2. Character
  3. Loudest on…
  4. Location
  5. Radiates to…
A
  1. Systolic
  2. Crescendo-descrescendo
  3. Expiration and sitting forwards
  4. 2nd intercostal space, right sternal edge
  5. Neck (carotid)
26
Q

Mitral regurgitation

  1. Heart cycle
  2. Character
  3. Loudest on…
  4. Location
  5. Radiates to…
A
  1. Sytolic
  2. Pansystolic
  3. Expiration, using the bell and the left lateral decubitus position
  4. Apex
  5. Axilla
27
Q

Aortic regurgitation

  1. Heart cycle
  2. Character
  3. Loudest on…
  4. Location
  5. Radiates to…
A
  1. Early diastolic
  2. Decrescendo
  3. Expiration whilst holding breath, sitting forwards
  4. 4th intercostal space, left sternal edge
  5. Left sternal edge
28
Q

Mitral stenosis

  1. Heart cycle
  2. Character
  3. Loudest on…
  4. Location
A
  1. Mid/late diastole
  2. Rumbling, decrescendo murmur after an opening snap in diastole
  3. Expiration, using the bell and the left lateral decbitus position
  4. Apex
29
Q

What can cause mitral stenosis?

A

Rheumatic heart disease

Infective endocarditis

30
Q

What is mitral stenosis associated with?

A

Malar flush
LV hypertrophy
Atrial fibrillation

31
Q

What is malar flush?

A

plum-red discolouration of the cheeks due to the back pressure of blood into the pulmonary system causing increased CO2 and vasodilation

32
Q

How can mitral stenosis cause LV hypertrophy?

A

When pushing against stenotic valve, muscle has to try harder -> hypertrophy

33
Q

How can mitral stenosis cause atrial fibrillation?

A

Atria struggles to push blood through stenotic valve causing strain and electrical disruption

34
Q

What can cause mitral regurgitation?

A 
Idiopathic weakening of valve with age
Ischaemic heart disease
Infective endocarditis
Rheumatic heart disease
Connective tissue disorders
35
Q

What is mitral regurgitation associated with?

A

Congestive cardiac heart failure

36
Q

How can mitral regurgitation cause heart failure?

A

Leaky valve reduced ejection fraction -> causes backlog of blood that is waiting to be pumped through left side of heart

37
Q

What can cause aortic stenosis?

A

Idiopathic aged related calcification

Rheumatic heart disease

38
Q

What is aortic stenosis associated with?

A

left ventricular hypertrophy

39
Q

What can cause aortic regurgitation?

A

Idiopathic age related weakness

Connective tissue disorders

40
Q

What is aortic regurgitation associated with?

A

Corrigan’s pulse

Heart failure

41
Q

What is corrigan’s pulse?

A

a collapsing pulse that rapidly appears and disappears as blood is pumped out by ventricles and then immediately flows back through the aortic valve into the ventricles

42
Q

How can aortic regurgitation cause heart failure?

A

Back pressure of blood waiting to get through left side of heart

43
Q

What is cardiovascular disease (CVD)?

A

Decreased blood flow to the heart, brain and body caused by atheroma or thrombosis

44
Q

What is the pathophysiology of CVD?

A

Plaques of fatty atheroma build up with causes arterial narrowing, or triggers a local thrombosis (blood clot) which blocks blood flow

45
Q

What are the risk factors for CVD?

A 
Lower socioecenomic status
South Asian ethnicities
Smoking
Poor diet
High cholesterol
High BP
Low physical activity
Obesity
Diabetes
High alcohol consumption

TCA 1 - Chest Pain (7 decks)

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