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Cardiovascular > Coronary heart disease > Flashcards

Coronary heart disease Flashcards

1
Q

What causes sudden cardiac death?

A

Stable plaque => unstable plaque => transient ischemia => cardiac arrest
Acute occulsion => acute MI => Cardiac arrest
Chronic closure => scarr formation => Cardiac arrect
Ischemic cardiomyopathy => cardiac arrect

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2
Q

How is anginal diagnosed?

A

A good clinical history

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3
Q

What do you need to ask about in an angina history?

A

Visceral pain from myocardial hypoxia- difficult to describe (gestures) pressig squeezing heavines, weight radiating to back, jaw, arms and teeth
Characteristic patterns of:
Provocation (exercise , stress, large meal, cold wind
Relief - rest GTN spray
Timing- usually lasts 1-2 minutes

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4
Q

What are the differential diagnosis of chest pain?

A

GI tract = oesophageal reflux, peptic ulcer pain, oesophageal spasm (relieved by GTN), billary cholic
MSK = injury or nerve root pain (dermatomal and prolonged)
CVS = Pericarditis- central and relieved by a change in posture which stops pericardial rubbing
Resp = Pleuritic chest pain- focal and exacerbated by breathing

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5
Q

WHat are the common presentations of MI?

A

Severe chest pain, associated sweating, neusea and vommiting, fear, adrenaline, sense of impending doom. Ongoing despite 10mg morphine

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6
Q

What is the presentation of PE?

A

Breathless, dull pain, pleuritic is a peripheral artery is affected

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7
Q

What is the presentation of aortic dissection?

A

Tearing, excruciating pain which eases. INcreased BP and massive ordeal

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8
Q

Angina is a clinical diagnosis but how is the presence of CHD confirmed?

A

Tests and investigations

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9
Q

Is it possible to have CHD without angina and angina without CHD?

A

Yes

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10
Q

What are the advantages and disadvantages of exercise testing?

A

+ Cheap, reproducible, Risk stratification (a positive test at low work load implies a poor prognosis, and a negative test at high workload implies a good prognosis)
- Poor diagnostic accuracy in women (false positives), submaxiaml tests (existing lung disease/arthritis may limit workload prematurely

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11
Q

When is exercise tolerance testing done occupationally?

A

For HGV drivers and pilots for fitness to work

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12
Q

What are the advantages and disadvantages for perfusion scanning?

A

+ non invasive, pharmacological stress in ledd mobile patients, more pricise than ETT, risk stratification
- Radiation and flase positives/negatives

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13
Q

What are the advantages and disadvantages of CT angiography?

A

+ NOn invasive, anatomical data, risk stratification

- Radiation (less than perfusion scanning), expensive, less precise than perfusion if Ca++ present

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14
Q

What are the advantages and disadvantages of catheter angiography?

A

+ gold standard, anatomical data, risk stratification and follow on angioplasty
- Risk 1 in 1000 death/stroke, radiation, contrast can cause renal dysfunction, rash, nausea

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15
Q

What is a catheter angiography?

A

A sheath inserted into radial/femoral artery and catheter advanced to coronary ostium. X ray contrast injected to outline coronary arteries and video fluoscopy images recorded in multiple views

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16
Q

What are the 3 main factors to CHD management?

A

Drug therapy
Lifestyle modification
Revascularisation

17
Q

Which drugs are commonly used in CHD?

A

Antiplatelets- asprin
Beta blockers to reduceheart rate and oxygen demand
Statin to reduce cholesterol
ACE inhibitor/ARB to reduce BP

18
Q

What is a CABG?

A

Coronary artery bypass graft

The diversion of blood around narrow or clotted parts of coronary arteries to improve perfusion

19
Q

What is the euroSCORE?

A

European system for cardiac operative risk evaulation

20
Q

What is the surgical technique for CABG?

A

1) Median sternotomoy
2) Use long saphenous vein or internal mamory artey
3) Put on cardiopulmonary bipass to stop the heart
4) Cardioplegia- heart is kept alive in a cold solution with salts inc K+ to stop the heart
5) Overnight in ITU, 7 days in hospital and 2-3 months off work
6) Risk of graft disease 8-10 years post opp (vein grafts are not designed for arterial pressure

21
Q

What are the complications of CABG?

A 
1-2% mortality, 2-3% stroke, 3% MI
AF
Sternal maluniion
Infection 
Renal failure
Cognitive impairment
Failure to recover- hard to be confident about life
22
Q

What is primary PCI?

A

Percutaneous coronary intervention

Performed by interventioal cardiologists i the cath lab

23
Q

How is PCI carried out?

A

1) Vascular access (radial or femoral artery)
2) Antiplatelet and anticoagulation therapy
3) Catheter to ostia of coronary arteries
4) Guidewire down vessel, ballons threaded over wire and stents implanted
5) Balloon catheter and wires removed

24
Q

What are the complications of primary PCI?

A 
0.8%death, 0.6% stroke, 1-2% MI
Renal failure
Bleedig 
Vascular complications 
Stent thrombosis 
Stent restenosis 
Emergency CABG if you cannot sort the problem
25
Q

What are the containdications for angiography and revascularisation?

A

Multivessel disease
Difuse disease
Diabetes (not absolute)
Comorbidities (eg over 80 years old)

26
Q

What is the SYNTAX trial?

A

PCI v CABG trial for severe Coronary artery disease

62 EU sites and 23 US sites

27
Q

What are the results of syntax trial?

A

No difference in 5 year mortality or 5 year stroke incidence with CABG or PCI
CABG slightly better in 5 year MI incidence

28
Q

Why is radial artery access preferred for PCI?

A

Duel artery supply to the hand
Superficial and easy to access
Compressable against bone to stop bleeding
No adjacent nerve or vein
But it is smaller and prone to spasm and asymptomatic occlusion occurs in 5% of patients

29
Q

What are the thrombolysis agents?

A

Streptokinase
Alteplase
Duteplase

30
Q

What are the advantages and disadvantages of thrombolysis?

A

+ no cath lab or theatre required- can be done in community

- Not as effective as angioplasty (increased death, stroke and pain

31
Q

Cost of primary PCI is very low per QALY if given quickly. T or F?

A

True

32
Q

What is the best managemeant for…

a) STEMI
b) ACS
c) Chronic stable angina

A

a) Primary PCI
b) angiography with a view to revascularisation
c) Revascularisation for severe symptoms at high risk
PCI or CABG should be determined by discussion

Cardiovascular (24 decks)

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