Coronary Heart Disease Overview Flashcards
Sudden death and CHD?
50% of deaths are sudden
2/3 of these being 1st manifestation / low risk
Development of cardiac arrest?
- Stable plaque->unstable plaque->Transient ischemia=CA
- Acute occlusion-> Acute MI=CA
- Chronic closure->scar formation =CA or Ischemic Cardiomyopathy = CA
Modifiable factors for having cardiac arrest?
Genetic profile Drugs/electrolytes Ischemic burden Hemodynamic fluctuations Autonomic variations
What is cardiogenic shock?
Inadequate system perfusion as a result of cardiac dysfunction
What can cause cardiogenic shock?
Acute MI-multivessel disease percluded LAD
Mechanical complications
How do you diagnose angina?
It is a clinical diagnosis- can be confirmed by history, examination not tests
Clinical diagnosis of angina?
- Visceral pain from myocardial hypoxia - hard to describe, Gestures
- Characteristic patterns of Provocation-exertion,cold, relief, timing (goes away when exertion stops)
- Characteristic background–risk factors
Patient could describe angina as?
Pressing, squeezing, heaviness, a weight
Radiating to arm, back, neck, jaw and teeth
Causes=Exertion stress, cold wind, after meals
Few minutes of rest relief it
Patient symptoms which indicate muscuoskeletal pain?
Dull, knifelike stabbing Fleeting or prolonged Focal- left submammary in shoulder No pattern, can be at rest No risk factors
Differential diagnosis fro chest pain relating to the GI tract?
Reflux, burning, acid, water brash- provoked by food
Peptic ulcer pain- boring,Point of ginger gesture,relief by antacids
Oesophageal spasm
Biliary colic
Differential diagnosis for chest pain in regards to musculoskeletal pain?
Injury- location, prolonged, exact
Nerve root pain- prolonged, character
Other differential diagnosis of chest pain?
Pericarditis - central, posture related
Pleuritic pain- focal exacerbated by breathing, sharp/catching
Emergency syndromes?
Myocardial Infarction - prolonged, severe
Pulmonary Embolus - breathlessness, dull
Dissection of aorta - tearing,excruciating, severe then eases
If a patient described what would it be?
Pressing pain in exercise but can resume after 5 mins
Angina
Angina can be tested for. True or False?
False. Angina is a CLINICAL diagnosis
when can people can have angina without coronary disease?
Anaemia
Pros of exercise testing?
Cheap
Reproducible
Risk stratification - +ve test at low workload implies poor prognosis
Cons of exercise test?
Poor diagnostic accuracy in important sub-groups (women)
Submaximal tests
Pros of perfusion imaging?
Non invasive
Pharmacological stress in less mobile patients
More precision than ETT
Risk stratification
Cons of perfusion imaging?
Radiation
False positives and negatives
Pros of CT angiography?
Non-invasive
Anatomical data and risk stratification
Cons of CT angiography?
Radiation
Less precise than angiography, particularly when calcium present
Cost
What is the gold standard test for angina?
Angiography
Process of angiography?
Sheath inserted into artery
Catheter advanced from wrist / groin to coronary ostium
X-ray contrast agent injected to outline coronaries
Video fluoroscopy recorded images in multiple views
Pros of angiography?
“Gold standard”
Anatomical and risk stratification
Follow-on angioplasty
Cons of angiography?
Risk 1:1000 death, stroke
Radiation
Contrast: renal dysfunction, rash, nausea
How to reduce risk of CHD?
Drugs
lifestyle Revascularization
Drugs to use for CHD?
Aspirin- antiplatelet
B blockers- Slow heart rate, reduce O2 demand
Statins-Reduces cholesterol
ACE Inhibitors-reduce BP
Lifestyle advice for CHD?
STOP SMOKING
Take exercise
Healthy balances diet
