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Pathophysiology > Cardiovascular Diseases - Coronary Heart Disease > Flashcards

Cardiovascular Diseases - Coronary Heart Disease Flashcards

1
Q

What is another name for coronary heart disease?

A

Ischemic (restriction of blood) Heart Disease

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2
Q

Give a definition of Coronary Heart Disease (CHD)

A
  • 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
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3
Q

What are the clinical signs and symptoms of atherosclerosis?

A
  • 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
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4
Q

What is angina?

A
  • 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
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5
Q

What are the risk factors for CHD?

A
  • increased risk of atherosclerosis
  • high blood pressure/hypertension
  • high levels of LDLs
  • low levels of HDLs
  • diabetes
  • smoking
  • obesity
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6
Q

What are the non-modifiable risk factors for CHD?

A
  • family history
  • age
  • ethnicity
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7
Q

How can we explore our suspicions of CHD in case Hx?

A
  • chest pain
  • palpitations
  • previous CVS issues
  • nausea
  • fatigue
  • SOB
  • dizziness
  • history of smoking
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8
Q

What medications are commonly prescribed to treat angina?

A
  • 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
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9
Q

What is Atherosclerosis?

A
  • hardening + narrowing of arteries
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10
Q

What are the risk factors for atherosclerosis?

A
  • dyslipidemia (high total, high LDL, or low HDL)
  • diabetes
  • cigarette smoking
  • family history
  • sedentary lifestyle
  • obesity
  • hypertension
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11
Q

What are the CVS Cardinal Questions?

A
  • chest pain
  • pain in your leg, arm, anywhere that has an artery
  • jaw, dental, neck pain
  • shortness of breath
  • fatigue
  • confusion
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12
Q

How can we explore our suspicions of CHD with observation?

A
  • sweating
  • breathing rate
  • general well being
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13
Q

How can we explore our suspicions of CHD with physical examination?

A
  • blood pressure
  • CVS examination
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14
Q

What does chest pain caused by Angina feel like?

A
  • 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
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15
Q

What are the clinical signs and symptoms of Angina?

A
  • indigestion
  • heartburn
  • weakness
  • sweating
  • nausea
  • cramping
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16
Q

What symptoms may Angina cause across the patient’s chest?

A
  • squeezing
  • pressure
  • heaviness
  • tightening
  • burning
  • aching
17
Q

Share are the severe symptoms that need emergency medical attention with Angina?

A
  • 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
18
Q

What is the medical term for a heart attack?

A
  • myocardial infarction
  • serious medical emergency in which blood supply to the heart is suddenly blocked, usually by a clot
19
Q

What other tests are available for CHD?

A
  • electrocardiogramme (ECG)
  • exercise stress tests
  • x-rays
  • echocardiogram
  • blood tests
  • coronary angiography
  • radionuclide test
  • magnetic resonance imaging (MRI) scans
  • computerised tomography (CT) scans
20
Q

What medicines prevent heart attacks and strokes?

A
  • low-dose aspirin to prevent blood clots
  • statins to reduce your cholesterol (blood fats) level
  • ACE inhibitors to reduce your blood pressure
21
Q

What is Angina a warning sign of?

A
  • higher risk of heart attack or stroke
22
Q

What is the recommendation if medicines aren’t helping control angina?

A
  • 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
23
Q

What lifestyle changes can help prevent or slow progression of CAD?

A
  • stop smoking
  • control blood pressure
  • check cholesterol
  • keep diabetes under control
  • get moving
  • eat healthy foods
  • maintain a healthy weight
24
Q

Give 3 significant risk factors for developing CHD

A
  • smoking
  • high LDLs/low HDLs
  • inactivity
  • obesity
25
Q

Why might your patient be advised to take aspirin following their diagnosis of coronary heart disease?

A
  • blood thinner to help prevent clots
26
Q

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?

A
  • 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.
27
Q

Why does diabetes increase your risk of CHD?

A
  • 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
28
Q

Is taking your patient’s blood pressure a good way to monitor their coronary heart disease?

A
  • 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
29
Q

What are the signs of costochondritis?

A
  • pain worse by particular posture (supine)
  • pressure on chest
  • deep breathing, coughing, sneezing or physical activity aggravates
30
Q

What are the complications of atherosclerotic plaques?

A
  • 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
31
Q

What is the location of angina?

A
  • 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
32
Q

How can you differentiate between angina in women and TMJ?

A
  • 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

Pathophysiology (12 decks)

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