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Cadiovascular Disease > Coronary Heart Disease > Flashcards

Coronary Heart Disease Flashcards

1
Q

What comes under Arterial Thrombosis?

A
  • Acute miocardial infarction (AMI)
  • Transient ischaemic attacks (TIA)
  • Cerebal vascular accident
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2
Q

Why does Arteriial Thrombosis occur?

A
  • Occurs as a result of rupture of athereoscleosis of plaque
  • Platelets deposition & vessels occlusion
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3
Q

What comes under Venous Thrombosis?

A
  • DVT
  • PE
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4
Q

Why does venous thrombosis occur?

A
  • Often occurs in normal vessels
  • Majoriry deep vein
  • Red thrombus.
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5
Q

What is CHD?

A

Condition in which the vascular supply to the heart by atheroma, thrombosis or spasm.
Inadequate blood supply -> decreased O2 to the heart -> ischaemic heart disease -> depending on the extent can cause :
- Stabe angina
- Acute coronary syndrome (ACS)
- Sudden death

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6
Q

What is stable angina?

A
  • Narrowing of the coronart arteries due to artheromatous plaque.
  • causes chest pain provoked by exercise, stress, heavy meals or extreme temp
  • Narrowed arteries unable to meet increased O2 during exercise.
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7
Q

What are the clinical symptoms of stable angina?

A
  • Central crushing chest pain
  • May radiate to jaw, neck, back or arm
  • Induced by exercise and releived by GTN
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8
Q

What is the management of stable angina?

A

Symptom control:
- S/L GTN for acute angina
- Antianginal - 1st line is β-blocker, CCB
- Add on - Long lasting nitrate, ivabradine, ranolazine / nicorandil.
Secondary prevention:
- Lifestyle changes
- Antiplatelet
- Statins.

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9
Q

What is Acute Coronary Syndrome?

A

**MI **
- ST Elevated MI (STEMI)
- Non-ST elevated MI (NSTEMI)
- Unstable angina (troponin positive ACS)

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10
Q

Troponin T & Troponin I

A
  • Released After 2-4 hrs, peak at 12 hrs & can persist for up to 7 days.
  • STEMI/NSTEMI -> Troponin >99th percentile cut off / upper reference limit
  • Unstable angina -> some changes in troponin lvl but does not meet criteria for MI
  • <0.4ng/ml ->ACS unlikely
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11
Q

What other things can cause an increase in troponin?

A
  • PE
  • HF
  • Myocarditis
  • CKD
  • Sepsis
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12
Q

What other enzymes rise in STEMI/NSTEMI?

A

Creatine Kinase:
- Peaks within 24hrs
- Normal within 48 hrs
Aspartate Transaminase (AST) & lactate:
- Non-specific
- Released from other parts of the body
- Not used routinely

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13
Q

What is STEMI/NSTEMI?

A
  • Thrombus forms at site of rupture of atheromatous plaque.
  • Severe & prolonged ischaemia
  • Causes death of cardiac muscle cells
  • STEMI - DMG to full thickness of cardiac muscle.
  • NSTEMI - DMG to partial thickness of cardiac muscle.
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14
Q

What is Unstable angina?

A
  • Decreases coronary blood flow & decreases O2 supply due to thrombus formation.
  • Causes partial blockage (Untable angina)
  • Complete blockage (STEMI/NSTEMI)
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15
Q

What are the clinical symptoms of STEMI/NSTEMI?

A
  • Severe chest pain, sudden onset, often at rest & constant.
  • Sweating
  • N&V
  • Restlessness
  • Pale
  • Grey
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16
Q

What are the clinical features of unstable angina?

A
  • Sudden deteriation in angina symptoms.
  • Often at rest, not releived by rest or S/L GTN
17
Q

What is the Immediate management of STEMI?

A
  • O2 - Releivs ischaemia
  • Diamorphine - Pain + add on antiemetic
  • Aspirin 300mg STAT
  • Clodipogrel - 300mg STAT
  • If stent not availbale then thrombolysis is required:
  • Steptokinase, Altepase, Releplase
  • Call to need time 1 hr, door to needle time 30 mins
  • S/E haemorrhage, stroke, reperfusion, arrhythmias, allergy.
  • Heparin (for first 48hrs after thrombolysis)
18
Q

What is secondary prevention of STEMI?

A
  • Antiplatelet (Aspirin + clopidogrel / ticagrelor/prasugrel) - DAPT for 12 months and then aspirin for lif
  • β-blocker (review after 12 months - continure if aslo HF)
  • ACEI
  • Statin - Atorvastatin 80mg
  • Lifestyle changes
19
Q

What is the immediate treatement of NSTEMI / Unstable angina?

A
  • O2
  • Diamorphine
  • Asiprin
  • Clopidogrel
  • Fandaparinux - until stable
  • No thrombolysis / Stent

Cadiovascular Disease (12 decks)

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