CAD Flashcards

1
Q

what is coronary artery disease

A

the narrowing of coronary arteries due to atherosclerosis (lipid deposition, inflammation, thrombosis)

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2
Q

chronic and acute coronary syndrome (4)

A

STEMI, NSTEMI, unstable angina, chronic angina

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3
Q

atherosclerotic plaque development steps

A
  1. fatty streak - endothelial dysfunction allows cholesterol to enter the bv wall, it is recognised as a foreign body which drives leukocyte modification and recruitment, foam cells form;
  2. plaque progression - smooth muscle cells migrate and there is altered matrix synthesis and degradation, due to inflammation and cholesterol levels driving it;
  3. plaque disruption - disturbed plaque integrity due to unstable/thin surface, thrombus forms due to rupture into bv which can occlude the artery
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4
Q

why is smoking a risk factor for CAD

A

the toxins damage the bv wall

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5
Q

main trigger factors for bv wall inflammation (4)

A

cholesterol crystals; neutrophil extracellular traps; atheroprone flow (turbulent); hypoxia

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6
Q

risk factors for atherothrombosis (12)

A

hypertension; hypercholesterolemia; diabetes; smoking; FH; obesity/metabolic syndrome; male; old age; ethnicity; socio-economic status; genetic profile; inflammatory markers

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7
Q

what is used to calculate the future risk of CVD event

A

QRISK2 - increased by 10% indicates treatment for cholesterol should be given

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8
Q

what areas of arteries are at particular risk from atherosclerosis

A

branch points and bifurcations due to turbulent flow

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9
Q

what areas of arteries are at a particularly high risk of atherosclerosis

A

branches and bifurcations due to turbulent flow

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10
Q

what is ischaemia due to

A

fixed vessel narrowing and abnormal vascular tone

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11
Q

what determines myocardial O2 supply (7)

A

coronary blood flow; coronary perfusion pressure; coronary vascular resistance; external compression; intrinsic regulation; local metabolites; endothelial factors; neural innervation

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12
Q

what determines myocardial O2 demand (3)

A

wall stress (Pr/2h); heart rate; contractility

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13
Q

what determines the effect n blood flow of stenosis (2)

A

the degree of narrowing; the amount of compensatory vasodilation the arterioles can achieve

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14
Q

what can abnormal vascular tone result in? (2)

A

inappropriate vasoconstriction of coronary arteries; loss of normal antithrombotic properties

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15
Q

why does angina occur

A

metabolic hyperaemia can no longer match myocardial perfusion to myocardial oxygen demand in exercise due to restricted blood flow

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16
Q

4 characteristics of angina (location, character, relieving/exacerbating factors, duration)

A

location - retrosternal, diffuse, may involve both sides + chest;
character - pressure, tightness, heaviness, occasionally burning sensation or chocking if in the neck, toothache if in jaw;
relieving/precipitating - provoked by exertion, more easily provoked after a heavy meal or cold weather, rapid relief w GTN;
duration - attacks last a few minutes only

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17
Q

features of a normal lumen (3)

A

patent lumen; normal endothelial function; platelet aggregation inhibited

18
Q

features of stable angina lumen (2)

A

lumen narrowed by plaque; inappropriate vasoconstriction

19
Q

features of unstable angina (4)

A

plaque rupture; platelet aggregation; thrombus formation; unopposed vasoconstriction

20
Q

features of variant angina (2)

A

no overt plaques; intense vasospazam

21
Q

chest pain differentials (11)

A

cardiac - angina, pericarditis;
GI - reflux(GORD), peptic ulcer, oesophageal spasm, biliary colic;
msk - costochondral syndrome (sharp pain, rib fractures, cervical radiculitis
other - pneumonia, PE (stabbing pain), anxiety, aortic dissection

22
Q

symptoms of PE

A

sudden SOB; chest pain; anxiety; palpitations

23
Q

diagnostic tests for CAD (4)

A

stress ECG; myocardial perfusion imaging, stress echo; stress MRI

24
Q

imaging for CAD (2)

A

CT coronary angiogram; coronary angiogram

25
what does a depressed ST segment in an ECG stress test indicate
ischaemia
26
shape of RCA on angiogram
'c' shaped
27
4 main coronary arteries
right coronary; left anterior descending; circumflex; left coronary
28
what is the first region to be damaged by ischemia
subendothelial region as it is furthest from blood supply
29
subendothelial vs transmural ischaemia ECG
subendothelial - ST depression transmural - ST lelevation
30
stable vs vulnerable plaques
stable - thick fibrous cap, small lipid pool vulnerable - think fibrous cap, large lipid pool, many inflammatory cells
31
what happens to a ruptured plaque
thrombogenic extracellular matrix exposed to lumen, thrombus formed; this can either be reabsorbed resulting in a narrower lumen and fibrous intima or in occlusion of the lumen
32
what marker is key in identifying if an MI has occured
troponin - cardiac specific troponin can be identified, this elevates if the heart is damaged
33
what can raised troponin indicate other than ACS
exercise; renal failure/other severe illness
34
what is a pathological Q wave
a Q wave that is >3mm, it often appears post MI due to wall damage, it persists in the ECG after other changes have reverted
35
NSTEMI ECG appearance
ST depression or T wave inversion; no pathological Q wave
36
post MI complications (7)
A -arrythmia C-congestive HF/cardiogenic shock T- thromboembolism R - rupture (V free wall, papillary muscle, septum) A - aneuyrsm P - pericarditis I - ischaemia D - dresslers syndrome/detah
37
what is Dressler's syndrome
inflammation of the sac surrounding the heart (pericarditis); the immune system responding to damage to heart tissue or damage to the pericardium
38
how does endothelial dysfunction contribute to ACS
reduced vasodilator and antithrombotic effect
39
dressler's syndrome symptoms
fatigue; weakness; pain worse on lying down; pleural effusion; increased WCC
40
what is pericardial friction rub (what does it sound like and why)
occurs due to the inflammation of the pericardium post MI and so the two layers rub against each other; grating, scratching, or rasping sound systolic and diastolic; best heard between the apex and sternum but may be widespread