Cardiovascular Diseases - Coronary Heart Disease Flashcards
What is another name for coronary heart disease?
Ischemic (restriction of blood) Heart Disease
Give a definition of Coronary Heart Disease (CHD)
- coronary arteries become narrowed by gradual build-up of fatty material (atheroma) with their walls
- coronary arteries supply heart muscle with oxygen-rich blood
- CHD develops when cholesterol builds up on the artery walls, creating plaques, narrowing the arteries, reducing blood flow to the heart
- A clot can sometimes obstruct the blood flow, causing serious health problems
- CHD develops as a result of injury or damage to the inner layer of a coronary artery
- This damage causes fatty deposits of plate to build up at the injury site
What are the clinical signs and symptoms of atherosclerosis?
- chest pain or angina
- pain in leg, arm and anywhere that has a blocked artery
- fatigue - too tired to do normal daily activities
- shortness of breath
- confusion
- patients with costochondritis might actually have angina
- weakness/dizziness
What is angina?
- chest pain caused by reduced blood flow to the heart muscles, not usually life threatening
- a warning sign that you could be at risk of CHD
What are the risk factors for CHD?
- increased risk of atherosclerosis
- high blood pressure/hypertension
- high levels of LDLs
- low levels of HDLs
- diabetes
- smoking
- obesity
What are the non-modifiable risk factors for CHD?
- family history
- age
- ethnicity
How can we explore our suspicions of CHD in case Hx?
- chest pain
- palpitations
- previous CVS issues
- nausea
- fatigue
- SOB
- dizziness
- history of smoking
What medications are commonly prescribed to treat angina?
- acute attacks e.g. glyceryl trinitaire (GTN)
- preventative e.g. beta-blocker (slows heart beat/reduces force) + calcium channel blockers to relax arteries, increasing blood supply to heart muscle
What is Atherosclerosis?
- hardening + narrowing of arteries
What are the risk factors for atherosclerosis?
- dyslipidemia (high total, high LDL, or low HDL)
- diabetes
- cigarette smoking
- family history
- sedentary lifestyle
- obesity
- hypertension
What are the CVS Cardinal Questions?
- chest pain
- pain in your leg, arm, anywhere that has an artery
- jaw, dental, neck pain
- shortness of breath
- fatigue
- confusion
How can we explore our suspicions of CHD with observation?
- sweating
- breathing rate
- general well being
How can we explore our suspicions of CHD with physical examination?
- blood pressure
- CVS examination
What does chest pain caused by Angina feel like?
- tight chest, dull or heavy - may spread to left arm, neck, jaw or back
- triggered by physical exertion or stress
- stops within a few minutes of resting
What are the clinical signs and symptoms of Angina?
- indigestion
- heartburn
- weakness
- sweating
- nausea
- cramping
What symptoms may Angina cause across the patient’s chest?
- squeezing
- pressure
- heaviness
- tightening
- burning
- aching
Share are the severe symptoms that need emergency medical attention with Angina?
- chest pain - chest can feel like it’s being pressed or squeezed by a heavy object, pain radiates from chest to jaw, neck, arms and back
- SOB
- feeling weak
- lightheaded
- overwhelming feeling of anxiety
What is the medical term for a heart attack?
- myocardial infarction
- serious medical emergency in which blood supply to the heart is suddenly blocked, usually by a clot
What other tests are available for CHD?
- electrocardiogramme (ECG)
- exercise stress tests
- x-rays
- echocardiogram
- blood tests
- coronary angiography
- radionuclide test
- magnetic resonance imaging (MRI) scans
- computerised tomography (CT) scans
What medicines prevent heart attacks and strokes?
- low-dose aspirin to prevent blood clots
- statins to reduce your cholesterol (blood fats) level
- ACE inhibitors to reduce your blood pressure
What is Angina a warning sign of?
- higher risk of heart attack or stroke
What is the recommendation if medicines aren’t helping control angina?
- coronary artery bypass graft (CABG) - section of blood vessel removed from another part of the body and used to reroute blood around blockage/narrowing
- percutaneous coronary intervention (PCI) - narrowed section of artery is widened using tiny tube called a stent
What lifestyle changes can help prevent or slow progression of CAD?
- stop smoking
- control blood pressure
- check cholesterol
- keep diabetes under control
- get moving
- eat healthy foods
- maintain a healthy weight
Give 3 significant risk factors for developing CHD
- smoking
- high LDLs/low HDLs
- inactivity
- obesity
Why might your patient be advised to take aspirin following their diagnosis of coronary heart disease?
- blood thinner to help prevent clots
A patient you have known for 5 years calls to tell you that they have recently been diagnosed with angina, and they would like some advice and help from you … what would you say?
- ask about what their doctor has told them about angina
- if they didn’t understand their diagnosis, speak to them about what the diagnosis meals
- tell them the risk factors for the disease
- ask them if they had been prescribed medication and make a note in the patient file of those medications
- ask them if they had a scan done or were having surgery
- tell them modifiable factors that put them at lower risk e.g. stop smoking, healthy nutrition, healthy body weight, exercise etc.
Why does diabetes increase your risk of CHD?
- high glucose levels can damage the artery walls
- blood clots then form around the walls to repair them
- those clots can cause atherosclerosis which can lead to narrowing or a blockage of the coronary arteries, reducing blood flow to the heart causing a myocardial infarction
Is taking your patient’s blood pressure a good way to monitor their coronary heart disease?
- With increasing age, there was a gradual shift from diastole to SBP and then to Pulse Pressure as predictors of CHD risk
- In patients <50 years of age, diastole was the strongest predictor.
- Age 50 to 59 years was a transition period when all 3 Blood Pressure indexes were comparable predictors,
- from 60 years of age on, diastole was negatively related to CHD risk so that pulse pressure became superior to systole
What are the signs of costochondritis?
- pain worse by particular posture (supine)
- pressure on chest
- deep breathing, coughing, sneezing or physical activity aggravates
What are the complications of atherosclerotic plaques?
- calcification - rigid vessels become fragile
- myocardial ischemia
- PAD
- renal artery stenosis
- plaque rupture => thrombus and infarction
- unstable angina
- myocardial infarction
- thrombotic stroke
- hemorrhage
- embolisation - travelling plaque = blood clot
- aneurysm - weak + bulging vessel
- abdominal aortic aneurysm
What is the location of angina?
- vague, barely troublesome
- can become rapidly severe, intense precocial crushing
- rarely described as pain
- most common beneath sternum
- can radiate to left shoulder, back of left arm into fingers, in the back, throat, jaw, teeth, occasionally down right arm and upper abdomen
- never above the ears or below umbilicus
- can be misdiagnosed as TMJ e.g. postmenopausal women
- can be mid-thoracic back pain
- time lag of 3-5 mins between increase in activity and onset of MSK symptoms caused by angina
- can be nocturnal if dream changes respiration, pulse rate and BP
How can you differentiate between angina in women and TMJ?
- most likely to present with TMJ/angina in post-menopausal women
- if jaw pain is steady, lasts a long time or is worst when waking up => teeth grinding
- if jaw pain comes and goes with physical activity/stress may be angina
