Coronary Heart Disease: Overview Flashcards
How are ventricular tachyarrhythmias caused from transient ischaemia in CHD?
Electrical activity is altered by ischeamic heart.
Longer QT interval is produced, ie the re-polarisation state is longer.
This causes more excitation of the myocardium:
Ventricular tachycardia–> V tachyarrhythmia–> MI.
Why does cardiogenic shock occur?
Inadequate system perfusion as a result of cardiac dysfunction.
If untreated= 90% mortality.
Where can acute MI often affect?
LAD
What is the important clinical diagnosis in CHD patients?
Angina
What are the typical descriptions regarding to chest pain in angina?
Pain is visceral
Descriptions:
Hard to describe, can be sharp, dull, local or radiating. “elephant on chest”
Gestures- hand/ tight fist on area of chest.
Use part of SOCRATES to explain presentations of Angina
S- central or side of chest.
O- on exertion, like exercise
C- can be sharp, pressing, heavy, dull, squeezing
R- can spread to teeth, jaw, neck and down the arms.
A- related to any other signs/symptoms?
T- can be again during exertion, or random
E- exercise or stress can be an exacerbating factor
S- depending on extent to which it is affects daily activities.
What are some differential diagnoses for chest pain?
- GI- Reflux, burning, acid, waterbrash
- Musculoskeletal- localised pain, tender, prolonged, character, exacerbated by moving area.
- Pericarditis- central, posture related
- Pleuritic - focal, exacerbated by breathing, sharp
What are some emergency diseases associated with chest pain?
- MI- severe, associated autonomic upset, could be painful even with morphine
- Pulmonary embolus- dull to percuss, breathlessness
- Aortic dissection- tearing, excruciating
What are some common tests used to confirm CHD?
- CT
- Exercise testing
- Angiogram
What are some pros/cons of exercise testing?
Pros- cheap, reproducible, + test at low workload= poor prognosis
Cons- Poor diagnostic accuracy in Imp sub-groups
Submaximal testing
What is blood perfusion scanning?
Detects area of high and low blood perfusion, to identify the ischaemic part of the heart.
What are some pros/cons of perfusion imaging?
Pros- Non invasive, pharmological stress in less mobile patients, Risk stratification
Cons- Radiation, false -/+
What is a CT angiography?
CT scan used to look at specific blood vessels, mainly heart vessels.
Pros/Cons of CT angiography?
Pros- Non invasive, Anatomical data & risk stratification
Cons- Radiation, Angiogram more precise, especially if Ca present. Cost.
What is angiography?
- Sheath inserted into artery
- Catheter inserted into arm/groin and moved up, into coronary ostium.
- X ray dye injected and marks the C arteries
- Video fluoroscopy records images in multiple views.
