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Cardiology > Angina, IHD and ACS > Flashcards

Angina, IHD and ACS Flashcards

1
Q

Cause of IHD

A

Limit of blood supply to the myocardium

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2
Q

Risk factors of IHD

A

Hypertension, Diabetes, Family History, Hyperlipidaemia, Sedentary Lifestyle, Alcohol and Smoking

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3
Q

Contents of atherosclerotic plaque:

A

Lipid, Necrotic Core, Connective Tissue and Fibrous ‘Cap’

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4
Q

Stages of atherosclerosis formation:

A
  1. Injury to endothelial cells
  2. Endothelial dysfunction
  3. Chemoattractants released
  4. leukocytes migrate into the vessel wall
  5. Fatty Streaks (aggregations of lipid-laden macrophages and T lymphocytes within the intimal layer)
  6. Fibrous plaques/advanced lesions (impede blood flow and prone to rupture)
  7. Plaque rupture (Balance shifts - cap becomes weak - plaque ruptures)
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5
Q

Types of angina

A

Stable Angina
Unstable Angina
Decubitus Angina
Variant (prinzmetal) Angina

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6
Q

Pathophysiology of Angina

A
  • A consequence of restricted coronary blood flow
  • O2 supply-demand mismatch
  • Impairment of blood flow
  • Increased distal resistance
  • Electro-hydraulic analogy
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7
Q

Epidemiology of Angina

A

Men - 5%

Women - 4%

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8
Q

Causes of Angina

A

Most Common: Atheroma

Rarer Causes: Anaemia, coronary artery spasm, AS, tachyarrhythmias, arteritis/small vessel disease

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9
Q

Signs of Angina

A

Levine’s sign: clenched fist over chest

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10
Q

Clinical presentation of angina (3 points)

A
  1. constricting/heavy discomfort - in the chest, jaw, arms or shoulders
  2. symptoms are brought on by exertion
  3. symptoms are relieved by rest or GTN spray
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11
Q

Investigations for angina and what would expect to see

A 
12 Lead ECG - ST elevation/depression
- Flat/inverted T waves
- Signs of past MI
Bloods, echo, chest x-ray
Further investigations: Exercise EEG, angiography and functional imaging
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12
Q

Precipitating factors for angina

A

Demand - emotion, cold weather, heavy meals
Others - HTN, tachyarrhythmia
Supply - Anaemia, hypoxia, polycythaemia, hypothermia

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13
Q

Features that make angina unlikely (2 points)

A
  • Pain that is continuous pleuritic or worse on swallowing

- Pain that is associated with palpitations, dizziness or tingling

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14
Q

Name 3 ways to modify the risk factors for someone with angina

A
  1. Stop smoking
  2. Exercise
  3. Weight loss
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15
Q

4 Different secondary preventions of cardiovascular disease

A
  1. Stop smoking, exercise, dietary advice, optimise hypertension and diabetes control (modifying risk factors)
  2. 75mg aspirin daily
  3. Address hyperlipidemia
  4. Consider ACE inhibitors
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16
Q

Pharmacological management of angina (There are 5)

A
  1. Aspirin
  2. Statins
  3. B-blockers (1st line anti-anginal) e.g. bisoprolol/atenolol
  4. Glyceryl trinitrate (GTN) spray
  5. Calcium channel blockers e.g. verapamil, amlodipine
17
Q

2 Types of acute coronary syndrome

A
  1. Unstable angina

2. Myocardial infarction

18
Q

Pathology of acute coronary syndrome

A

Plaque rupture -> Thrombosis -> Inflammation

Rarer Causes: Emboli, coronary spasm, vasculitis

19
Q

Definition of unstable angina

A
  • Cardiac chest pain at rest with a crescendo pattern

- New-onset angina

20
Q

Presentation of ACS (3 points)

A
  1. Cardiac chest pain at rest (>20 mins)
  2. Cardiac chest pain with a crescendo pattern
  3. New-onset angina
    Associated symptoms: Nausea, sweatiness, SOB, palpitations
21
Q

Investigations of ACS (4 points)

A
  1. History
  2. ECG
  3. Troponin (no significant increase)
  4. CXR
22
Q

DDx of ACS

A

Angina, pericarditis, myocarditis, aortic dissection, PE, reflux

23
Q

What is a STEMI?

A

Complete occlusion of a coronary artery, full-thickness damage to the heart muscle.
Diagnosed on an ECG.
Pathological Q-wave.

24
Q

What is an N-STEMI?

A

Partial occlusion of a major CA or full occlusion of a minor CA.
Retrospective diagnosis - after troponin.
Partial-thickness damage

25
Q

Risk factors for an MI?

A

Age, male, smoking, HTN, DM, hyperlipidemia, family history, obesity/sedentary lifestyle

26
Q

Pathophysiology of an MI

A
  1. Rupture/erosion of fibrous cap
  2. platelet aggregation and adhesion, localised thrombosis, vasoconstriction, and distal thrombus embolisation
  3. Thrombus formation -> myocardial ischaemia
  4. plaque rupture/ fissure and thrombosis
  5. MI, ischaemic stroke, critical leg ischaemia or sudden CVS death
27
Q

Symptoms of an MI

A 
Acute central chest pain
Lasts >20 mins
Nausea
Sweating
SOB
Palpitations
'Silent' : Elderly/diabetic
28
Q

Signs of an MI

A 
Distress
Anxiety
Pallor
Sweatiness
Hyper/Hypotension
Tachy/Bradycardia
4th heart sound
29
Q

How is a troponin assay used?

A
  • 1 Measurement at least 6 hours after the pain started
  • No elevation: No MI
  • Elevated: repeat after another 3 hours
  • Significant rise/fall and other diagnostic factors: MI confirmed
30
Q

What changes would be seen on an ECG of a person with a STEMI? (5 points)

A
  1. ST-elevation
  2. Tall T waves
  3. LBBB
  4. T wave inversion
  5. Pathological Q wave
31
Q

What changes would be seen on an ECG of a person with an N-STEMI? (1 Point)

A

ST depression, T wave inversion

32
Q

What other investigations would be performed to confirm an MI? and what would you expect to see?

A

Troponin I/T - raised
Myoglobin - raised
Transthoracic echocardiography

33
Q

Hospital Management of an MI

A 
MONA
M- Morphine (5-10mg)
O- Oxygen (if hypoxic)
N- Nitrates e.g. GTN
A- Aspirin and clopidogrel
34
Q

Pre-hospital management of MI

A

Aspirin (300mg chewable)
GTN (sublingual)
Morphine

35
Q

2 Types of coronary revascularisation

A
  1. PCI within 120 mins of medical contact

2. CABG

36
Q

MI Complications

A 
DARTH VADER
D- death
A- arrhythmias
R- ruptured septum
T- tamponade
H- heart failure
V- valve disease
A- aneurysm of ventricles
D- Dressler's syndrome
E- embolism
R- reoccurrence of ACS

Cardiology (3 decks)

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