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CDM > cardiovascular pathology > Flashcards

cardiovascular pathology Flashcards

1
Q

Myocardial ischemia

A

occurs when blood flow to the heart muscle (myocardium) is obstructed by a partial or complete blockage of a coronary artery by a buildup of plaques

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2
Q

3 clinical syndromes CAD presents as

A

Angina Pectoris, MI and Chronic CAD with Congestive Heart failure

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3
Q

CAD

A

Coronary Artery Disease

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4
Q

Angina Pectoris

A

chest pain or discomfort due to coronary heart disease

It occurs when the heart muscle doesn’t get as much blood as it needs

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5
Q

MI

A

Myocardial Infarction

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6
Q

Myocardial Infarction

A

Heart attack Infarction refers to a blockage in the blood supply to the heart

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7
Q

Chronic CAD with congestive heart failure

A

a long-term condition in which your heart can’t pump blood well enough to meet your body’s needs

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8
Q

Coronary Artery Disease

A

Hypertension, Coronary artery narrowing/occlusion and thrombosis

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9
Q

Angina Pectoris

A

Recurrent attacks of sub-sternal chest pain caused by transient myocardial ischemia

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10
Q

3 patterns of angina

A

stable (less than 2 minutes)

Prinzmetal variant

unstable (crescendo)

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11
Q

stable angina

A

caused by a decreased myocardial perfusion in relation to increased myocardial demand

physical exercise, stress, emotion

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12
Q

unstable angina

A

chest discomfort or pain caused by an insufficient flow of blood and oxygen to the heart.

frequent prolonged (>20mins) attack

attacks during rest

caused by disruption of atherosclerotic plaque, partial occlusion of a coronary artery

old, clammy, sweaty , severe anxiety

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13
Q

typical angina

A

…..

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14
Q

Stable Angina symptoms

A

chest pain caused by a release of molecules that stimulate sympathetic afferent nerves.

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15
Q

How is stable angina relieved

A

relieved by rest or administering vasodilator
* Glycerol Trinitrate (spray or tablet form)

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16
Q

NICE Guidelines: for the initial assessment of a patient
presenting with acute coronary syndromes (NICE 2020)

A

Formal risk assessment should include a full clinical history (age, previous myocardial infarction and previous PCI or CABG)

a physical examination

A resting 12-lead ECG, looking for a dynamic or unstable patterns that indicate MI

blood tests (creatinine, glucose, haemoglobin

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16
Q

NICE Guidelines: for the initial assessment of a patient
presenting with acute coronary syndromes (NICE 2020)

A

Formal risk assessment should include a full clinical history (age, previous myocardial infarction and previous PCI or CABG)

a physical examination

A resting 12-lead ECG, looking for a dynamic or unstable patterns that indicate MI

blood tests (creatinine, glucose, haemoglobin

17
Q

Physical and examination Acute Coronary Syndromes NICE (2020).

A

a physical examination should be carried out, to determine:

haemodynamic status, signs of complications e.g. pulmonary oedema, cardiogenic shock

signs of non-coronary causes of chest pain e.g. aortic dissection

18
Q

clinical examination Acute Coronary Syndromes NICE (2020).

A

clinical history including:

characteristics of pain

other associated symptoms

Hx cardiovascular disease

any cardiovascular risk factors

details of previous investigations for similar symptoms of chest pain

19
Q

ECG electrocardiogram

A

records the electrical activity of the heart at rest

it also provides information about the heart rate, and rhythm.

abnormal traces can show if there is enlargement due to hypertension or evidence of previous MI.

20
Q

ECG are helpful in diagnosis of…

A

NSTEMI/STEMI (Non) ST Elevation Myocardial Infarction

21
Q

ST elevation indicates…

A

the full thickness of myocardial infarct

(transmural - occurring across wall of blood vessel)

22
Q

slight depression of ST segment indicates

A

a partial thickness infarct (NSTEMI) (partial occulusion of a coronary artery)

23
Q

biomarkers

A

…..

24
Q

NSTEMI accounts for….

A

30% of heart attacks

25
Q

STEMI accounts for

A

70% of all heart attacks

26
Q

STEMI occur by..

A

developing a complete occlusion
of a major coronary artery previously affected by atherosclerosis. This causes a full thickness
damage of heart muscle.

27
Q

NICE GUIDELINES - coronary angiography with follow on PCI 2020

A
  • offer immediate coronary angipgraphy to people with unstable angina/NSTEMI if clinical condition is not stable.
  • consider Coronary angiography with follow on PCI within 72 hours of admission for those with angina/NSTEMI who have immediate or high risk of adverse cardiovascular events
28
Q

pathway to coronary angiogram….?

A

person is diagnosed with unstable angina/NSTEMI

  1. provide information
  2. intitail driug test
  3. assess risk of future adverse cardiovascular events
    5/6 . (5) further drug treatment if there is low risk. (6) drug treatment if there is intermmediate-high risk
  4. when to offer coronary angiogram
29
Q

Coronary Angiogram with PCI procedure

A

Patient pre-care
* Environment considerations
* Patient position
* Anaesthesia (local)
* Incision/insertion of catheter
* Femoral/brachial access
* Catheter/guide wire
* Use of contrast media
* Balloon/stenting
* Diagnostic visualisation
Time
* Patient Post-care

30
Q

Benefits of coronary angiography

A

Has highest resolution of all angiographic imaging

  • flat panel detectors enhance image uniformity and brightness
  • shows site and degree of stenosis + real time imaging
  • less invasive
  • cost effective
  • reduces symptoms of angina
  • patient tolerance to procedure
31
Q

limitations to Coronary angiography

A
  • invasive - has potential risks to patient
  • chance of excessive bleeding
  • infection
  • risk of injury to catheterized artery
    -irregular heart rhythms
  • possible allergic reaction to contract
  • high radiation
32
Q

Alternative treatment

A
  • coronary artery bypass grafting - used for patients with contr-indications for conventional angiogram/pci. Those who have muti-vessel disease and those with failed CCA with pci
33
Q

three lines of
investigation for diagnostic
testing for stable angina (NICE Guidelines)

A

First line - 64 slice CT coronary angiography
second line - non invasive functional testing if CTCA shows CAD of uncertain functional significance.

3rd line conventional coronary
angiography when results of non invasive
functional imaging are inconclusive
Recent onset chest pain with suspected cardiac origin (NICE, 2016)

34
Q

advantages of CT in diagnosing stable angina

A

Accurate – comparable to conventional angiography in terms of spatial resolution

fastcompared to conventional coronary angiography
* 64 slices per rotation
* Can scan entire heart quickly in single breath hold

Non invasive – less complications than for conventional angiography

May show other causes of chest pain

Calcium scoring – performed prior to angio – calculates risk of CAD; low dose, unenhanced triggered scan

35
Q

Disadvantages of cardiac CT

A

High radiation dose

calcium and stents can cause artefacts

Hard to see stents smaller than 3mm

Contraindicated in acute myocardial infarction;
asymptomatic patients

36
Q

What is meant by CAD of uncertain functional significance

A

refers to significant CAD found on CT.

70% or greater stenosis in at lest one major epicardial artery or 50% or greater stenosis of left main coronary artery

uncertain functional significance will be those that do not meet the above

37
Q

Myocardial perfusion scintigraphy with single photon
emission computed tomography (MPS with SPECT

A

determines the affect of CAD on the myocardium - helps to determine if the stenosis is significant by showing perfusion of myocardium at stress and rest

has a similar dose to angiography (6-8mSv)

3D images

however patients must keep very still.

38
Q

Stress echocardiography

A

Determines the affect of CAD on the
myocardium – helps in determining if
stenosis is significant by showing wall motion

Performed at rest and under stress

ultrasound > no IR; No contrast agent
required
* Provides real-time images along with the
heart
* Non-invasive transthoracic
* Takes 15-60 mins

39
Q

first-pass contrast-enhanced magnetic
resonance (MR) perfusion

A

Determines the affect of CAD on the
myocardium – helps in determining if stenosis
is significant by showing perfusion of
myocardium at stress and rest

Performed at rest and Stress achieved by
exercise or dobutamine

Dynamic injection of gadolinium
* Adequately perfused myocardium
highlights rapidly
* Poorly perfused myocardium will highlight
slowly
* Dead Myocardium will remain dark (no
contrast up-take

non-invasive

40
Q

MR imaging for stress-induced wall motion
abnormalities

A

Determines the affect of CAD on the
myocardium – helps in determining if
stenosis is significant by showing wall motion

uses cine Gradient Echo Sequences: “Bright
Blood imaging

maged real time
* Flowing blood appears bright
* Normal heart shows increased motility
when stressed
* Ischaemic myocardium is hypokinetic

shows ventricular function

however, it requires local expertise

CDM (7 decks)

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