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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

24
NSTEMI accounts for....
30% of heart attacks
25
STEMI accounts for
70% of all heart attacks
26
STEMI occur by..
developing a complete occlusion of a major coronary artery previously affected by atherosclerosis. This causes a full thickness damage of heart muscle.
27
NICE GUIDELINES - coronary angiography with follow on PCI 2020
- 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
pathway to coronary angiogram....?
person is diagnosed with unstable angina/NSTEMI 2. provide information 3. intitail driug test 4. 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 7. when to offer coronary angiogram
29
Coronary Angiogram with PCI procedure
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
Benefits of coronary angiography
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
limitations to Coronary angiography
- 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
Alternative treatment
- 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
three lines of investigation for diagnostic testing for stable angina (NICE Guidelines)
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
advantages of CT in diagnosing stable angina
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
Disadvantages of cardiac CT
High radiation dose calcium and stents can cause artefacts Hard to see stents smaller than 3mm Contraindicated in acute myocardial infarction; asymptomatic patients
36
What is meant by CAD of uncertain functional significance
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
Myocardial perfusion scintigraphy with single photon emission computed tomography (MPS with SPECT
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
Stress echocardiography
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
first-pass contrast-enhanced magnetic resonance (MR) perfusion
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
MR imaging for stress-induced wall motion abnormalities
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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