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Respiratory and Cardio > Cardiac consequences of atheroma > Flashcards

Cardiac consequences of atheroma Flashcards

1
Q

The ‘most important’ consequence of atheroma is

A

Death (ventricular fibrillation)

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2
Q

Anatomy of atheroma:

A
  1. Fibrous cap

2. Soft interior

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3
Q

What makes up soft interior of atheroma?

A 
Lipids
Cholesterol
WBCs
Proteins
Calcium
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4
Q

Non-modifiable risk factors for atheroma;

A

Age
Gender
FHx
Ethnicity

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5
Q

Modifiable risk factors for atheroma:

A 
Smoking
Diabetes
Obesity
Lipids
Hypertension
Stress, pollution, lack of exercise
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6
Q

Timeline of atheroma

A
  • Fatty streak
  • Fibrous cap formation
  • Core of lesion becomes necrotic (atheroma)
  • Thinning and rupture of cap
  • Arterial occlusion
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7
Q

Why is a fibrous cap formed?

A

Bodies attempt to stabalise things

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8
Q

Why is an atheroma a symptomatic?

A

Positive remodelling - vessel widens

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9
Q

What occurs when a cap ruptures?

A

Inflammatory process - platelets adhere - thrombus formed

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10
Q

Stable angina =

A

Angina on exertion

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11
Q

What is included in acute coronary syndrome?

A

Unstable angina

Myocardial infarction

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12
Q

How to diagnose stable angina:

A
  • Hx
  • Examination (often normal)
  • Stress testing
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13
Q

3 types of stress testing:

A
  1. Exercise ECG
  2. Stress echo
  3. Myocardial perfusion scan
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14
Q

What would happen on an exercise ECG with stable angina?

A 
Normal = normal ECG
Exercise = ST depression
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15
Q

What type of imaging is an echo?

A

Ultrasound

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16
Q

What happens in a stress echo with angina?

A

Part of heart supplied will increased contractility, part of heart with narrowing won’t contract as well

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17
Q

What happens in a myocardial perfusion scan?

A

Inject isotope - shows perfusion. Take images at rest and during exercise.

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18
Q

How to diagnose MI:

A

History
ECG
Enzymes

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19
Q

Most common blocked arteries in MI:

A
  1. Left anterior descending
  2. Right coronary artery
  3. Left circumflex
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20
Q

Left anterior descending supplies:

A

Anterior wall

LV septum

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21
Q

Right coronary artery supplies:

A

Inferior/posterior wall

LV septum

22
Q

Left circumflex supplies:

A

Lateral wall of LV

23
Q

Subendothelial MI:

A

NSTEMI

24
Q

Transmural MI

A

STEMI

25
Q

In a normal ECG, what is Q =

A

First downward line after P

26
Q

In a normal ECG, what is R =

A

First upward line after P

27
Q

In a normal ECG, what is S =

A

First downward line after R

28
Q

What part of the ECG do we look at in an MI?

A

ST segment

29
Q

Name the ‘12 leads’ on an ECG?

A 
avR
avL
avF
I
II
III
V1-V6
30
Q

Leads for left anterior descending (anterior) =

A

V1-V6

31
Q

Leads for right coronary artery (inferior)

A

II, III, avF

32
Q

Leads for circumflex artery (lateral)

A

I, avL, V5, V6

33
Q

Enzymes to check for makers of MI:

A

CK-MB
Troponin I
Troponin T
Myoglobin

34
Q

Most sensitive markers of MI

A

Troponin

35
Q

Troponin is sensitive but not

A

Specific

36
Q

What else may increase troponin?

A 
hypertension
septicaemia
PE
subarachnoid haemorrhage
AF
37
Q

What makes up the troponin complex?

A

Troponin C: ca2+
Troponin I: inhibitory
Troponin T: tropomyosin binding

38
Q

To diagnose MI, what has to happen to troponin?

A

Rise and/or fall in troponin level measured a few hours apart (need multiple blood tests)

39
Q

Complications of MI: 0-24 hrs

A

Arrhythmia
Cardiac death
Cardiogenic shock

40
Q

Complications of MI: 1-3 days

A

Pericarditis

41
Q

Complications of MI: up to 2 weeks

A

Myocardial rupture

42
Q

Complications of MI 3 weeks +

A

Heart failure

43
Q

What can occur if myocardial rupture is incomplete

A

False aneurysm

44
Q

What would a patient present with with interventricular septum rupture:

A

Hypotension
Loud murmur
Very ill

45
Q

Papillary muscle most likely to break:

A

Posteriomedial

46
Q

Heart failure symptoms:

A 
SOB
Peripheral oedema
Orthopnoea
PND
fatigue
47
Q

What can happen with a left ventricular aneurysm:

A

Arrythmias

Thrombus formation

48
Q

Sudden cardiac death can occur in what MI?

A

STEMI

49
Q

Treatment for NSTEMI:

A

Anti-platelets
LWMH
Statin
Anti-ischemic

50
Q

Examples of anti-ischemic

A

Beta-blockers

Nitrates

51
Q

Treatment for STEMI:

A

Quick reperfusion:

  • Fibrinolysis
  • Angioplasty
  • Percutaneous coronary intervention

Respiratory and Cardio (14 decks)

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