coronary heart disease Flashcards
what are the two types of thromboembolic diseases
arterial thrombosis
venous thrombosis
what is arterial thrombosis and what can it cause
MI, TIA
rupture of atherosclerotic plaque causing vessel occlusion
white thrombi
what is venous thrombosis and what can it cause
DVT, PE
can happen in any vessels, red thrombi
usually in deep vein of leg
what is coronary heart disease
when the vasculature of the heart is impeded by atheroma, thrombosis or spasm, causes decreased blood flow and ischaemia
what diseases come under CHD
ACS -MI, unstable angina
stable angina
what is the epidemiology of CHD
4% of UK have symptoms
more common in males until the menopause
124000 acute MI/year
aetiology of CHD
atherosclerosis and clot rupture
what are the main risk factors for CHD
age
gender
family history
smoking
HT/HL
obesity
what are some other risk factors for CHD
diabetes
ethnicity
alcohol
stress
pathophysiology of CHD
- Imbalance between oxygen demand and supply
what is stable angina
narrowing of coronary arteries due to atheromatous plaque, results in chest pain provoked by stress/exercise/heavy meals
what are symptoms of stable angina
central crushing chest pain, may radiate to jaw, neck, back, arms
no ECG/cardiac enzyme changes
what is the management for stable angina
GTN for symptoms control
antianginal
1. beta blocker / CCB
2. long acting nitrate, ivabradine, ranolazine, nicorandil
secondary prevention for stable angina
lifestyle advice
antiplatelet
atorvastatin 80mg
what is ACS - MI
- Thrombosis forms at site of rupture of atheromatous plaque
- Severe and prolonged ischaemia
- Death of cardiac muscles and enzyme release from cells
what is the difference between NSTEMI and STEMI
STEMI - damage to full thickness of cardiac muscle
NSTEMI - damage to partial thickness of muscle
symptoms of MI
- ST elevation in STEMI
- T wave inversion/Q wave changes in NSTEMI
- increased troponin
- severe chest pain
- sweating, breathlessness, N&V, restlessness
immediate management for STEMI
oxygen
diamorphine and antiemetic
aspirin 300mg stat
clopidogrel 300/ticagrelor 180/prasugrel 60 STAT
PPCI
(if C/I thrombolysis <1hr)
what other cardiac enzymes can be tested for when testing for MI/unstable angina
creatine kinase - CK-MB cardiac specific
aspartate transaminase - non specific
C/I for thrombolysis
recent surgery
peptic ulcer
uncontrolled HT
<6hr since start
thrombolysis side effects
haemorrhage
allergies
arrythmias
stroke
secondary prevention of a STEMI
dual antiplatelet - 12 m aspirin for life
beta blocker - 12m + if HF
ACEi
atorvastatin 80mg
lifestyle
symptoms of unstable angina
sudden deterioration of angina symptoms
not relieved by rest or GTN
STEMI ruled out
immediate management of STEMI/unstable angina
oxygen
diamorphine plus antiemetic
aspirin 300mg stat
clopidogrel 300/ticagrelor 180/prasugrel 60 STAT
fondaparinux until stable
NO PPCI
secondary unstable angina/STEMI management
6 month CVD risk prediction using GRACE - if >3% - angio and PCI
dual antiplatelet - 12 m aspirin for life
beta blocker - 12m + if HF
ACEi
atorvastatin 80mg
lifestyle
what is an angiography
○ Thin catheter introduced to coronary circulation
○ x-ray contrast material to allow observation of coronary stenosis
what is PCI - percutaneous coronary intervention
- angioplasty - balloon inserted and inflated at obstruction
- stenting - wire mesh inserted to keep stenosis open
what are the two types of stent that can be used in PCI
bare metal - overtime will become overgrown by endothelium - stenosis
drug eluting - anti-proliferative drug - tacrolimus to stop overgrowth
what is a primary PCI (PPCI)
PCI but with clot removal - gold standard STEMI treatment
