Angina, IHD Flashcards
1
Q
What is ischemic heart disease
A
heart problems caused by narrowed vessels
2
Q
what can cause IHD
A
- increased myocardial workload
- coronary artery occlusion
- insufficient oxygen rich blood supply
3
Q
non modifiable risk factors for IHD
A
Family history
age
ethnicity s asian
4
Q
modifiable risk factors
A
smoking
poor nutrition
sedentary lifestyle
alcohol
stress
HTN
obesity
DM
5
Q
What is angina
A
- constricting discomfort in front of chest, neck, shoulders, jaws or arms
-precipitated by physical exertion - relieved by rest
6
Q
What is stable angina
A
central crushing chest pain but
it is relevied by rest of GTN spray
7
Q
what is unstable angina
A
when the symptoms come on randomly whilst at rest
Cardiac chest pain with crescendo pattern
8
Q
what is unstable angina an example of
A
acute coronary syndrome
9
Q
GS investigation for angina
A
CT coronary angiography
10
Q
what does ct coronary angiography involve
A
injecting contrast and taking CT images timed with the heart beat to give a detailed view of coronary arteries
11
Q
Other investigations of IHD
A
ECG- usually normal
lipid profile
FBC
hba1c- to exclude DM
12
Q
Principles of angina manegement
A
R- Refer to cardio
A- advise about diagnosis
M-medical management
P- procedural or surgical interventions
13
Q
Immediate and long term medical management for angins
A
immediate- GTN spray
long term- beta blocker- bisoprosol or calcium channel blocker ( amlodipine )
14
Q
2nd line management for angina
A
CCB or beta blockers
15
Q
What does the gtn spray do
A
-used as required
-causes vasodilation and helps relieve symptoms
16
Q
Secondary prevention of stable angina
A
A- aspirin
A-atoravastin
A- ACE inhibitor
A- already on a beta blocker
17
Q
what is acute coronary syndrome
A
thrombus from an atherosclerotic plaque blocking a coronary artery
18
Q
what does ACS cause
A
- unstable angina
- STEMI
-NSTEMI
19
Q
RCA SUPPLIES
A
RA
RV
Inferior aspect of LV
posterios septal area
20
Q
What does STEMI mean
A
ST- elevation myocardial infarctio
21
Q
What does NSTEMI mean
A
Non - st elevation myocardial infarcation
22
Q
Presentation of ACS
A
- CENTRAL CONSTRICTING CHEST PAIN RADIATING TO JAW/ARMS
- sweating
- shortness of breath
23
Q
Making a diagnosis would involve ?
A
ECG
24
Q
If there is st elevation or new left bundle branch block what is the diagnosis
A
STEMI
25
What would an ecg show for NSTEMI
- ST segment depression
- Deep T wave inversion
- Pathological Q waves
26
If there is no ST elevation after performing an ECG what would you do and what would the diagnoses be
- troponin blood tests
- raised troponin and ecg changes= NSTEMI
- normal troponin and no ecg changes then = unstable angina
27
STEMI management
M- morphine
O- oxygen therapy is sats below 94%
N- nitrates
A- aspirin 300mg
Second anti platelet drug should be given such as clopidogrel
PPI within 90 mins
If not then thrombolysis
28
management for NSTEMI
MONA
USE grace score to predict 6 month mortality + risk of further cardio events
- anything other than lowest risk should also be given prasugrel or ticagrelor unless they have a high risk of bleeding where PO clopidogrel is better
- fondaparinux
29
Secondary prevention of ACS
ACEi
Clopidogrel
Aspirin
Beta blocker
30
Post MI complications
Death
Rupture of heart septum/ papillary muscles
Edema
Arrythmias
Aneurysm
Dresslers syndrome
31
Diagnosis for unstable angina involves
History
Ecg
Troponin
32
Myocardial infarction normally occurs when and how does it present
Unremitting Chest pain
Usually severe but may be mild or absent occurs at rest
Associated with sweating , breathlessness, nausea
One third occur in bed at night
33
Initial management of MI from being at home
Get into hospital quickly
Paramedics - If ST elevation then contact primary pci for transfer
Take aspirin 300mg immediately
Pain relief
34
Hospital management of MI
Make diagnosis
Bed rest
Oxygen therapy if hypoxic
Pain relief
Consider beta blocker
Consider other anti angina medication
35
Cause of acs
Rupture of an atherosclerotic plaque and consequent arterial thrombus
36
What is troponin
• Protein complex regulates actin:myosin contraction
• Highly sensitive marker for cardiac muscle injury
37
Role of thrombin
Activates platelets
Final factor in coagulation cascade as it cleaves fibrin to fibrinogen
38
3 point definition of angina
1- central crushing pain
2- brought on with exertion
3- relieved with 5 mins rest or GTN spray
39
Most common options for p2y12 inhibitors
Clopidogrel
Prasugrel
Ticagrelor
40
What do anti coagulants do
Inhibit fibrin formation , platelet activation
41
what is vasculitis
AN inflammatory and variably necrotic process centred on blood vessels that may involve arteries , veins or capillaries
42
immune background of vasculitis
Deposition of immune complexes
* Direct attack on vessels by antibodies
* Cell mediated immunity
* Viral infection
* Serum sickness = mode
43
what is dresslers syndrome
post myocardial infarction syndrome
localised immune response and causes pericarditis
44
what is the presentation of dresslers syndroem
pleuritic chest pain
low grade fever
pericardial rub
45
how to diagnose dresslers syndroem
ECG- ST elevation and T wave inversion
Echocardiogram
raised inflammatory markers
46
what is left sisded cardiac failure
PULMONARY congestion and then overload of right side
47
IHD predisposing factord
Age
Cigarette smoking
Family history
Diabetes mellitus
Hyperlipidemia
Hypertension
Kidney disease
Obesity
Physical inactivity
Stress
Male
48
exacerbating factors related to supply of angina
Anemia
Hypoxemia
Polycythemia
Hypothermia
Hypovolaemia
Hypervolaemia
49
exacerbating factors related to supply of angina
Anemia
Hypoxemia
Polycythemia
Hypothermia
Hypovolaemia
Hypervolaemia
50
exacerbating factors of demand to do with angina
Hypertension
Tachyarrhythmia
Valvular heart disease
Hyperthyroidism
Hypertrophic cardiomyopathy
51
environmental factors of angina
exercise
cold weather
heavy meals
emotional stress
52
when does myocardial ischemia occur ?
when there is an imbalance between the heart's oxygen demand and supply, usually from an increase in demand and a limited supply
53
what can cause a limited supply
1. Impairment of blood flow by proximal arterial stenosis
2. Increased distal resistance eg left ventricular hypertrophy
3. Reduced oxygen-carrying capacity of blood eg anemia
54
what occurs in prinzmetals angina
vessels become narrow with coronary spasm
55
history of IHD
Personal details (demographics, identifiers)
Presenting complaint
History of PC + risk factors
Past medical history
Drug history, allergies
Family history
Social history
Systematic enquiry
56
CARDIAC symptoms of IHD
Chest pain
breathlessness
- no fluid retention
-palpitation
-syncope or pre-syncope
57
TREATMENT for ischemic heart disease
- reassure
-lifestyle; smoking, weight, exercise, diet
-advice for emergency
- medication
- revascularisation
58
ST depression is ?
ischemia
59
gold standard test for IHD
PERFUSION MRI
60
2ND line management medicine for angina
calcium channel blocker
61
beta blocker effect on the heart for angina
reduce heart rate
reduce contractility
reduce workload
reduce oxygen demand
62
side effects of b blockers
tiredness
bradycardia
erectile dysfunction
cold hands and feet
63
b blockers contraindications
SEVERE ASTHMA- ABSOLUTE ASTHMA
64
what do nitrates do for angins
expands venous capacity
reduces preload
dilates coronary arteries
65
SE of nitrates
HEADACHE
66
what do calcium channel blockers do for angian
DILATE arteries
decreases afterload
reduces oxygen demand
67
what two types of meds cause gastric ulcers
Aspirin
NSAID
68
what does ace inhibitor do for angina
LESS ANG2 produced
less vasocontriction
69
What is CABG
coronary artery bypass graft
70
Main difference between stable unstable and prinzmetal angina
Stable and unstable show st segment depression
Prinzmetal shows st elevation
71
diagnostic features of acs
Unstable angina - Cardiac chest pain + abnormal/normal ECG + normal troponin
NSTEMI - Cardiac chest pain + abnormal/normal ECG (but not ST-elevation) + raised troponin
STEMI - Cardiac chest pain + Persistent ST-elevation/new LBBB (note that there is no need for a troponin in this case)
72
diagnosis of nstemi involves
Cardiac chest pain
Newly abnormal ECG which is NOT ST-elevation
Raised troponin (with no other reasonable explanation)
73
diagnosis of stemi
ST segment elevation >2mm in adjacent chest leads
ST segment elevation >1mm in adjacent limb leads
New left bundle branch block (LBBB) with chest pain or suspicion of MI
74
non acs reasons as to why troponin may be raised
Myocardial infarction
Pericarditis
Myocarditis
Arrythmias
Defibrillation
Acute heart failure
Pulmonary embolus
Type A aortic dissection
Chronic kidney disease
Prolonged strenuous exercise
Sepsis
75
Changes in v1-v4 would suggest
occlusion in ANTERIOR LAD
76
Changes in lead 2 ,3 and avf would suggest
inferior occlusion of right coronary
77
changes in lead 1 v5-v6 would suggest
lateral circumflex occlusion
78
right coronary leads are
lead 2
lead 3
avf
79
what would a nstemi show on ech
st segment depression - almost upside down
