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cardio lectures phase 2 > chronic coronary synrome d > Flashcards

chronic coronary synrome d Flashcards

1
Q

what is angina

A

a mismatch of oxygen supply and demand

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2
Q

commonest reason for angina

A

IHD

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3
Q

predisposing factors for IHD

A

• Age
• Cigarette smoking
• Family history
• Diabetes mellitus
• Hyperlipidemia
• Hypertension
• Kidney disease
• Obesity
• Physical inactivity
• Stress

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4
Q

exacerbating factors that affect oxygen supply

A

• Anemia
• Hypoxemia
• Polycythemia
• Hypothermia
• Hypovolaemia
• Hypervolaemia

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5
Q

exacerbating factors that affect oxygen demand

A

• Hypertension
• Tachyarrhythmia
• Valvular heart disease
• Hyperthyroidism
• Hypertrophic cardiomyopathy

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6
Q

environmental risk factors that make IHD worse

A
  • cold weather
  • heavy meals
  • emotional stress
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7
Q

when does myocardial ischaemia occur

A

when there is an imbalance between the hearts oxygen demand and supply, usually from an increase in demand eg exercise accompanied by limitation of supply

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8
Q

3 reasons for limited blood supply

A
  1. Impairment of blood flow by proximal arterial stenosis
  2. Increased distal resistance eg left ventricular hypertrophy
  3. Reduced oxygen-carrying capacity of blood eg anemia
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9
Q

what is ohms law

A

V = IR
so
change in P = QR

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10
Q

4 other types of angina

A
  1. prinzmetals angina (coronary spasm)
  2. microvascular angina ( syndrome x)
  3. crescendo angina
  4. unstable angina
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11
Q

how to take a history for IHD

A

• Personal details (demographics, identifiers)
• Presenting complaint
• History of PC + risk factors
• Past medical history
• Drug history, allergies
• Family history
• Social history
• Systematic enquiry

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12
Q

cardiac symptoms

A

chest pain (tightness/discomfort)
breathlessness
fluid retention
palpitation
syncope or pre can scope

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13
Q

questions to ask to do with angina pain 9 (OPQRST)

A

Onset
Position (site)
Quality (nature / character)
Relationship (with exertion, posture, meals, breathing and with other symptoms) Radiation
Relieving or aggravating factors
Severity
Timing
Treatment

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14
Q

factors pointing towards ischaemic cardiac pain

A

• Character
• Location
• Provoking factors
• Relieving factors
• Associated symptoms
• Associated risk factors

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15
Q

what is the differential diagnosis of myocardial ischaemia when presented with chest pain

A

• Pericarditis/ myocarditis
• Pulmonary embolism/ pleurisy
• Chest infection/ pleurisy
• Dissection of the aorta
• Gastro-oesophageal (reflux, spasm, ulceration)
• Musculo-skeletal
• Psychological

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16
Q

treatment for angina

A

• Reassure
• Lifestyle
– smoking
– Weight
– Exercise
– diet
• Advice for emergency
• Medication
• Revascularisation

17
Q

what investigations for angina

A

routine bloods
lipids
ECG

18
Q

impact of beta blockers on heart

A

decrease heart rate
decrease LV contractility
decrease cardiac output
decrease oxygen demand

19
Q

side effects of beta blockers

A

tiredness, nightmares
bradycardia
erectile dysfunction
cold hands and feet

20
Q

what does aspirin do

A

cyclo-oxygenase inhibitor

decrease prostaglandin synthesis

decrease platelet aggregation, antipyretic, anti inflammatory , anaglgesic

21
Q

side effect of aspirin

A

gastric ulceration

22
Q

gp level treatment of angina

A

aspirin
GTN
beta blocker
statin

23
Q

hospital level treatment of angina

A

ACE inhibitor
long acting nitrate
revascularisation
Ca ++ channel blocker
potassium channel opener
ivabradien

24
Q

pros of PCI revascularisation

A

less nvasive
convenient
repeatable
acceptable

25
Q

cons of PCI revascularisation.

A

risk stent thrombosis
risk restenosis
can’t deal with complex diseas
dual antiplatelet therapy

26
Q

pros of CABG revascularidation

A

prognosis
deals with complex disease

27
Q

cons of CABG revascularisation

A

invasive
risk of stroke, bleeding
can’t do if frail, comorbid
one time treatment
length of stay
time for recovery

28
Q

who can you not give beta blockers to

A

people who suffer from asthma because it causes bronchospasms

29
Q

what do nitrates do

A

they are venodilators
arterioles dilate
decrease BP
decrease after load
decrease venous return
decrease preload

30
Q

what do Ca++ channel blockers do

A

decrease LV contractions
decrease work
decrease heart rate
decrease oxygen demand
decrease after load

cardio lectures phase 2 (5 decks)

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