CVS 10 (Ischaemic Heart Disease 1) Flashcards
What could cause central tightening chest pain?
Myocardial ischaemia
What could cause central sharp chest pain?
Pericarditis
What could cause tearing pain, which begins in central back and descends down back?
Aortic dissection
What could cause lateral sharp stabbing chest pain, often worsening on inhalation and coughing?
Respiratory causes ie:
- Pneumonia
- Pneumothorax
- Pulmonary embolism
What could cause chest and epigastric burning pain?
GI causes ie:
- GORD
- Gastric band
(many more)
What could cause localised, tender chest pain?
MSK causes:
- Trauma ie cracked ribs
- Muscle pain
- Bone metastases
What usually relieves pericardial pain?
Leaning forward
Name the non-modifiable risk factors for coronary artery disease:
- Increasing age
- Male > Female
- Family history
- South Asian / African-Caribbean Ethnicity
Name the modifiable risk factors for coronary artery disease:
- Hyperlipidaemia
- Smoking
- Hypertension
- Diabetes
- Lack of exercise
- Obesity
- Low intake of Fruit/Veg
Describe the plaque which causes stable angina:
Stable/Simple plaque
Small necrotic core
Thick fibrous cap
What is the presentation of stable angina?
Hx of moderate central tightening pain on exertion, relieved by rest
What are the possible ECG signs of stable angina?
- Normal
- ST depression
- T wave inversion
Which serum biomarkers are associated with stable angina?
No associated serum biomarkers.
What is the short-term treatment of stable angina? How do they improve symptoms?
Sublingual organic nitrates ie Glycerol trinitrate
- Increase production of NO
= venodilation, decreases pre-load of heart
What is Glycerol trinitrate, and what is it used to treat?
Sublingual organic nitrate
Treats angina attack (stable angina)
Name some of the long-term treatments for stable angina:
- Modify risk factors (lower cholesterol, increase exercise, stop smoking, lose weight etc)
- Long-acting nitrates
- Beta-blockers
- Ca2+ Channel blockers
- Statins
- Aspirin
- Revascularisation (1) Percutaneous angioplasty and stenting, 2) Coronary artery bypass grafting)
Name the 2 types of surgery interventions used to treat stable angina:
1) Percutaneous angioplasty + stenting
2) Coronary Artery Bypass Grafting
Name 3 vessels that can be used for a Coronary Artery Bypass Graft:
1) Radial artery
2) Internal mammary artery
3) Saphenous vein (reversed due to valves)
Describe the plaque which causes unstable angina:
Unstable/complicated plaque
Large necrotic core
Thin fibrous cap
Which type of angina is not relieved by sublingual nitrates?
Unstable angina
What are the possible ECG findings in unstable angina?
- Normal
- ST depression
- T wave inversion
Name some of the treatments for unstable angina:
- IV opioids
- Oxygen (if sats<94%)
- Antithrombotics
- P2Y12 receptor antagonist
- IV nitrates
- IV beta-blockers
- Statins
- Revascularisation (1) Percutaneous angioplasty and stenting, 2) Coronary artery bypass grafting)
What is the difference between an NSTEMI and a STEMI?
NSTEMI = incomplete obstruction to blood flow to myocytes STEMI = complete obstruction to blood flow to myocyes
Name the 2 types of acute myocardial infarction:
1) NSTEMI
2) STEMI
List some of the symptoms of an acute MI:
- Severe persistent central crushing chest pain
(with or without radiation, commonly to left arm/neck) - Sweating, pallor
- Nausea, vomiting
- Anxious, breathless, faint
What are the possible ECG findings in an NSTEMI?
- Normal
- ST depression
- T wave inversion
What are the posisble ECG findings in a STEMI?
- Pathological Q wave
- ST elevation
- T wave inversion
Which ECG finding in a STEMI indicates transmural necrosis?
Pathological Q wave
Why are P2Y12 receptor antagonists used in the treatment of an acute MI?
P2Y12 binds to Gq coupled receptor, inducing platelet aggregation
P2Y12 antagonist reduces platelet aggregation
If an acute MI shows abnormal ECG findings in leads II, II and aVF, what artery is blocked?
Right coronary
If an acute MI shows abnormal ECG findings in leads V1 - V4, what artery is blocked?
LAD (Left Anterior Descending)
If an acute MI shows abnormal ECG findings in leads V5-V6, I and aVL, what artery is blocked?
Circumflex
If an acute MI shows abnormal ECG findings in leads V1-V6, I and aVL, what artery is blocked?
Proximal Left Coronary artery
If an acute MI shows tall R wave in leads V1-V2 in an ECG, which leads are blocked?
Right coronary artery
Name the artery which supplies the right atrium and right ventricle:
Right coronary artery
Name the artery which supplies the right ventricle, left ventricle and AV septum:
LAD (Left anterior descending)
Name the artery which supplies the Left atrium and Left ventricle:
Circumflex artery
Name the artery which supplies the Left atrium, left ventricle and AV septum:
Proximal left coronary artery
