Cardiovascular revision Flashcards
what ECG leads show the right coronary artery
aVF, 2, 3
what side of the heart do leads aVF, 2, and 3 represent
inferior
what ECG leads represent the left anterior descending artery
V1-V4
what side of the heart do leads V1-V4 show
anterior and septal
what ECG leads represent the left circumflex artery
V5, V6, aVL, 1
what side of the heart do leads V5, V6, aVL and 1 show
lateral
what makes the S1 heart sound
mitral and tricuspid closure
what makes the second heart sound
aortic and pulmonary valve closure
What does S3 heart sound show
rapid ventricular filling in early diastole
when is the S3 heart sound normal
young/pregnant people
What pathology does the S3 heart sound mean
mitral regurg and heart failure
What is the S4 heart sound
pathological gallop
what causes the pathological gallop (S4)
due to blood forced into stiff hypertrophic ventricle (LVH + aortic stenosis)
what are the two broad categories of ischaemic heart disease
angina and MI
what causes central crushing chest pain
myocardial ischaemia as a result of reduced flow in the coronary arteries
what are the three categories of angina pain
1) central crushing chest pain +/- radiating to neck/jaw
2) brought on by exertion
3) relieved with 5 mins rest or GTN spray
what are the three acute coronary syndromes
unstable
NSTEMI
STEMI
what are the levels of ischaemia/infarction in the three types of ACS
unstable - severe ischaemia
NSTEMI - partial infarction
STEMI - transmural infarct
what is the QRISK score
predicts risk of CVD in 10 upcoming years
(score of 10+ = 10% + risk in next 10 years)
what should be started with a 10+ score in QRISK
lipid lowering therapy - statins = primary prevention
what are the 4 types of angina
stable
unstable
prinzmetals
decubitus
what is stable and unstable angina
stable - normal 3 part definition
unstable - pain at rest, not relieved with GTN or inactivity
what is prinzmetals angina
due to coronary vasospasm (not CV vessel atherogenesis)
who might have prinzmetals angina
cocaine users
what would an ECG show in prinzmetals angina
ST elevation
what is decubitus angina
induced when patient lies flat
risk factors for ischaemic heart disease
obesity
T2DM
HTN
smoking
age (older)
male
FHx
cocaine use
what are the three steps of atherogenesis
fatty streaks
intermediate lesions
fibrous plaques (advanced)
where does the fatty streak form and in what age group and how does it occur
appears in internal wall
less than 10 y/o
T-cells and lipid laden macrophages (foam cells)
what occurs in the intermediate lesions
foam cells (bigger, taken up lipids), T-cells + vascular smooth muscle cells
platelets also aggregate and adhere to site, inside vessel lumen
what occurs in the fibrous plaques
large lesions (foam cells, T-cells, smooth muscle, fibroblasts, lipids with a necrotic core) develop fibrosis cap over top of lesion
at what percent of lumen occlusion does symptoms of stable angina begin to occur
70-80%
symptoms of ischaemic heart disease
central crushing chest pain +/- radiate to jaw/neck
nausea
sweating
fatigue
dyspnoeic weak breathing
diagnosis for stable angina
1st line -ECG - resting = normal, exercise induced (ischaemic) results in change
GS - CT angiography = stenosed atherosclerotic arteries
treatment for symptoms of stable angina
GTN sublingual spray
lifestyle modifications to treat stable angina
decrease weight
stop smoking
healthy diet
pharmacological treatment for angina
1) CCB (amlodipine) (heart failure = CI) or beta-blocker (bisoprolol)(astham = CI)
2)CCB + Beta-blocker
3) CCB + BB + antianginal - ivabradine or long-acting nitrates
what CCB are not appropriate for angina and why
non-rate limiting; can cause excessive bradycardia
-not verapamil or diltiazem
surgical options for angina (ischaemic heart disease)
revascularisation
PCI - balloon stent coronary artery
CABG - bypass graft (LAD bypassed by LMA)
pros and cons of PCI and CABG
PCI + less invasive, - risk of stenosis
CABG + better prognosis, - more invasive
what are the two types of MI and what causes them
type 1 - IHD
type 2 - increase demand or cavasospasm
what are the three categories for ACS
unstable angina
NSTEMI
STEMI
what are the ECG changes seen after an MI
hyperacute T waves
pathologically deep Q waves
LBBB
What is the occlusion, infarction, ECG and trop and creatine kinase status in unstable angina
partial occlusion of minor coronary artery
no infarction, ischaemia only
normal ECG - maybe some ST depression / T wave inversion
No trop/CK change
What is the occlusion, infarction, ECG and trop and creatine kinase status in NSTEMI
major / partial occlusion of total minor coronary artery
sub-endothelial infarction (area far away from CA occlusion dies)
ECG shows ST depression and T wave inversion and no Q waves
Elevated trop
What is the occlusion, infarction, ECG and trop and creatine kinase status in STEMI
total occlusion of major CA
there is transmural infarction
ST segment elevation in local leads + Q waves
elevated trop and CK due to infarction
is trop or CK a better marker for ACS
trop has a shorter half-life and may be better a few days after event
symptoms of ACS
same as stable angina, but pain is at rest and not relievable
palpitations and may be more severe
diagnosis of ACS
ECG
biomarkers
CT angiogram - shows extent of occlusion
acute treatment of ACS episode
morphine
O2 (if sats <94%)
GTN
aspirin (300mg)
clopidogrel (75mg)
what is the GRACE score
mortality risk of patients with ACS from MI (w/in 6 months-3years)
what to do in a NSTEMI/unstable angina with a high risk GRACE score
immediate angiogram + consider PCI
STEMI treatment
PCI - w/in 12 hours of symptom onset / <2 hours of first medical contact
thrombolysis if >12hours with alteplase
what can be used in long term prevention for ACS
beta-blocker (life)
aspirin (300mg, then 75mg for life)
atorvastatin (80mg life)
ACE-i (life)
clopidogrel (75mg for 12mnths)
complications of ACS
short term - HF due to vent fibrillation, mitral incompetence, LV free wall rupture, cardiogenic shock
longer than 2 wks - dressler syndrome (autoimmune pericarditis), HF, LV aneurysm, heart literally becomes saggy
