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1st Year Medicine > Coronary Heart Disease > Flashcards

Coronary Heart Disease Flashcards

1
Q

What clinical syndromes are included in CHD?

A

Stable angina, ACS, sudden cardiac death and heart failure.

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2
Q

What systems are included in a differential diagnosis of chest pain?

A

GI tract - reflux, peptic ulcer pain, oesophageal spasm and biliary colic.
MSK - injury and nerve root pain.
Pericarditis.
Pleuritic pain.

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3
Q

What kind of pain/ associated symptoms do we get with reflux?

A

Burning, acidy, water brash (excess salivation). Provoked by food.

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4
Q

What is peptic ulcer pain like?

A

Epigenetic, boaring, point of finger gesture. Relieved by antacids.

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5
Q

What is pericarditis pain like?

A

Central and posture related.

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6
Q

What is pleuritic pain like?

A

Focal, exacerbated by breathing, sharp and catching.

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7
Q

What is Angor animi and what can it be associated with?

A

Serious pathos hydrological States such as hypoxia, MI and transfusion reactions.

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8
Q

What symptoms do we get with a PE?

A

Breathlessness, dull maybe pleuritic pain.

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9
Q

What pain do we get with aortic dissection?

A

Tearing, excruciating.

Severe then eases.

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10
Q

How can we make a clinical diagnosis of angina?

A

Visceral pain from myocardial hypoxia. Hard to describe, may use a lot of gestures.
Characteristic patterns of provocation, relief and timing.
Characteristic background risk factors.

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11
Q

What are the pros and cons of exercise tolerance testing?

A

+ cheap, reproducible and risk stratification.

- poor diagnostic accuracy in important sub groups and sub maximal tests.

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12
Q

What are the pros and cons of perfusion imaging?

A

+ non invasive, pharmacological stress in less mobile patients, more precise than ETT.
- radiation and false positives/negatives.

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13
Q

What are the pros and cons of CT angiography?

A

+ non invasive, anatomical data.

- radiation, less precise than angiography and expensive.

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14
Q

What happens during angiography?

A

Sheath inserted into an artery. Catheter advanced from wrist/groin to coronary ostium. X-ray contrast injected. Video fluoroscopy records videos of outlines.

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15
Q

What are the pros and cons of angiography?

A

+ gold standard, anatomical information and can do angioplasty.
- 1in 1000 risk of death, stroke, radiation and contrast can cause: renal dysfunction, rash and nausea.

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16
Q

What is the surgical technique for a CABG? What happens during recovery?

A

Median sternotomy.
Long saphenous vein or internal mammary artery harvest.
Cardio pulmonary bypass.
Cardioplegia. Cessation of heart activity.
Overnight in ITU.
7 days in hospital.
2-3 months off work.
Risk of graft disease 8-10 years post op.

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17
Q

What are some of the complications of CABG?

A

Death, stroke, MI, a fib, infection, cognitive impairment, sternal male ion and renal failure.

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18
Q

What are some of the complications of PCI?

A

Death, stroke, MI, renal failure, bleeding, vascular complications, stent thrombosis, stent restenosis.

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19
Q

What is the technique for PCI?

A

Gain vascular access. Administer anti platelet drugs and anticoags. Feed catheter to ostium of artery. Pass guidewire down the vessel. Balloons threaded over the wire and stent implanted. Everything except stent removed.

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20
Q

What are the symptoms for angiography?

A

Severe symptoms and high risk patients.

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21
Q

What are complications of stenting?

A

Stoke, contrast nephropathy and bleeding.

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22
Q

What are some stent failures?

A

Failure to: deliver, expand, to expand without perforation and to remain patent.

23
Q

What are the pros and cons of radial artery access?

A

+ dual supply to the hand. Superficial, compressible with no adjacent nerves or veins.
- smaller, prone to spasm and 5% chance of suffering occlusion.

24
Q

What is another name for the brachiocephalic trunk?

A

Innominate artery.

25
Q

What three vessels come off the Innominate artery?

A

Right subclavian, internal and external carotid.

26
Q

What three vessels come off the arch of the aorta?

A

Innominate artery, left common carotid and the left subclavian.

27
Q

What does the left common carotid branch into?

A

Left external and internal carotid.

28
Q

What are the branches of the abdominal aorta?

A

Coeliac axis/trunk, superior mesenteric, right renal and the inferior mesenteric.

29
Q

What branches come off the common iliac artery?

A

Internal and external iliac.

30
Q

What branches come off the common femoral artery?

A

The deep and superficial femoral arteries.

31
Q

What is claudication?

A

Muscle ischaemia. Oxygen demand on exercise.

32
Q

His do we grade claudication?

A

Using Fontaine stage. I, IIa, IIb, III, IV.

III gives pain at rest and IV gives tissue loss.

33
Q

What are risk factors for intermittent claudication?

A

Male, increasing age, diabetes, smoking, hypertension, hypercholesterolaemia and fibrinogen.
Alcohol is protective.

34
Q

How do we investigate lower limb ischaemia?

A

Non invasive - measurement of ABPI and duplex ultrasound scanning.
Invasive - magnetic resonance angiography, CT angiography and catheter angiography.

35
Q

What is ABPI?

A

Ankle pressure/brachial pressure.

36
Q

What is a normal ABPI?

A

0.9-1.2

37
Q

What is an ABPI showing claudication?

A

0.4 - 0.85

38
Q

What is an ABPI showing severe claudication?

A

0-4.5

39
Q

What is the treatment for limb ischaemia?

A

Guardian therapy -

Stop smoking, lower lipids, anti platelet, hypertension, diabetes management and life style issues.

40
Q

How can we improve the symptoms of claudication?

A

Realistic expectations, exercise training, drugs angioplasty and stenting.

41
Q

What exercise is recommended for treatment of limb ischaemia?

A

30 mins 3 times a week for a minimum of 6 months.

42
Q

What are the symptoms of critical limb ischaemia?

A

Toe/foot ischaemia happening when lying or sleeping. Pain at rest.
Ulcers/gangrene - severe ischaemia plus damage.
Pain worse at night. Helped by sitting and putting leg in a dependent position. Helped by getting up and walking about.

43
Q

What are two major risk factors for PAD?

A

Smoking - 1 in 10 intermittent claudication patients will lose a leg within 5 years of they continue to smoke.
diabetes - 45% of all major amputees are diabetic.

44
Q

What is the treatment for critical limb ischaemia?

A

Realistic expectations, analgesia, angioplasty/stenting and surgical reconstruction/amputation.

45
Q

Why amputate a limb?

A

When it’s life or limb.

46
Q

What dictates the amputation level of a limb?

A

How it will heal and the function.

47
Q

What four different levels of lower limb amputation levels do we get?

A

Transtibial
Through the knee.
Transfemoral
Hip disarticulation.

48
Q

What will need to happen to a below the knee amputation in 15% of people?

A

It will have to be converted to above the knee.

49
Q

What is the epidemiology of intermittent claudication and critical limb ischaemia?

A

Males over the age of 55

50
Q

What is the aetiology of intermittent claudication and critical limb ischaemia?

A

Smoking, hypertension, diabetes, high cholesterol.

51
Q

What is the pathology of intermittent claudication and critical limb ischaemia?

A

Atherosclerosis.

52
Q

What are the investigations for intermittent claudication and critical limb ischaemia?

A

ABPI, Dulles and angiography.

53
Q

What are the outcomes of intermittent claudication and critical limb ischaemia?

A

Smoking have limb loss of greater than 10 %. In non smokers under 1 % of patients lose a limb.

54
Q

What are the big 5 risk factors for CHD?

A

High BP.
High cholesterol.
High blood sugar.
Smoking and genetics.

1st Year Medicine (64 decks)

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