Coronary Heart Disease Flashcards
What are some of the conditions that occur in those with coronary heart disease?
Angina (Stable or unstable)
NSTEMI - Non-ST Elevated Myocardial Infarction (Type I and II)
STEMI - ST Elevated Myocardial Infarction
How can Coronary Heart Disease lead to cardiac arrest?
Occlusion of the coronary arteries can cause ischaemia and acute myocardial infarction
This leads to fibrosis of the myocardium, making it electrically unstable, leading to ischaemic cardiomyopathy
With some modifiers such as ischaemic burden, autonomic variation, some drugs and genetics, this can lead to cardiac arrest
What is meant by VSD?
Ventricular Septal Defect (Hole in the ventricular septum)
What is meant by a Type I Myocardial Infarction?
Ischaemia of the myocardium due to partial (NSTEMI) or complete (STEMI) occlusion of the coronary arteries by an atheromatous plaque and thrombus
What is meant by a Type II Myocardial infarction?
Ischaemia of the myocardium caused by another disease that increases the oxygen demand to the heart, while oxygen supply is not increased (Not caused by atheroma formation)
How is a type II myocardial infarction diagnosed?
Symptoms of MI
Abnormal ECG (STEMI)
Troponin in the blood due to cardiac injury
What is the common SOCRATES description for stable angina?
S - Site - Chest (Hard to localise)
O - Onset - During exercise or physical activity
C - Character - Squeezing, heaviness
R - Radiating - To arm, back, neck, jaw
A - Assoc symptoms - X
T - Timing - Usually patterns of timing
E - Exacerbating - Exertion, stress, cold (Reliefed by rest or GTN spray)
S - Severity - X
What are some Differential diagnoses of chest pain relating to the GI tract and their characteristics?
Reflux - Burning, water brash, food provoked
Peptic ulcer - Epigastric, boring, relief by antacids
Oesophageal spasm
Biliary colic (Gallstone trapped in duct)
What are some differential diagnoses of chest pain relating to the musculoskeletal system and their characteristics?
Injury - Exact location, prolonged, exacerbated by movement
Nerve root pain
What are some differential diagnoses of chest pain relating to the pleura and pericardium and their characteristics?
Pericarditis - Central, posture related
Pleurisy - Focal, exacerbated by breathing, sharp, catching pain
What are some emergency differential diagnoses of chest pain and their characteristics?
Myocardial infarction - Severe, associated autonomic upset, agor amini, ongoing pain despite >10mg morphine
Pulmonary embolism - Breathlessness, dull, pleuritic pain
Aortic dissection - tearing, excruciating, severe and then eases as dissection stops
What is agor amini?
The impending sense of death or doom, commonly associated with a myocardial infarction
What are some common scans to test for Coronary Heart Disease?
Exercise Stress Testing
Perfusion Scanning
CT Angiography
Angiography
What are the advantages of exercise testing?
It is cheap, reproducible and a positive test at a low workload can show a poor prognosis (Determines severity)
What are the disadvantages of exercise testing?
It has a poor diagnostic accuracy in certain, important groups (e.g. elderly may not be able to do exercise because of age)
What happens in perfusion scanning?
A radioactive tracer is given which is taken up by the heart tissue
Stress due to exercise or medication will show gaps in tissue uptake due to ischaemia
What are the advantages of perfusion scanning?
It is non-invasive
It is much more precise than exercise testing
It allows for risk stratification, to determine the correct level of care
What are the disadvantages of perfusion scanning?
It involves radiation
It can give false positives and negatives
What are the advantages of CT angiography?
It is non-invasive
It can provide anatomical data and risk stratification to determine the correct level of care
What are the disadvantages of CT angiography?
It involves radiation from CT scanning
It is less precise than normal angiography, especially in calcified heart walls
It is expensive
What occurs during angiography?
A sheath is inserted into either the radial or femoral artery and is passed into the coronary ostium (Opening to coronary arteries)
This then injects an X-ray contrast agent into the arteries so that is can be imaged
What are the advantages of angiography?
It is gold standard
It provides anatomical and risk stratification
What are the disadvantages of angiography?
There is a 1/1000 risk of death and stroke
It involves radiation from the X-ray
Contrast can cause renal dysfunction, rash and nausea
