CVS Flashcards
What is acute limb ischemia
blockage of peripheral artery
Pathophy of acute limb ischemia
blockage reduced perfusion causing ischemia
5 RF of acute limb ischemia
- Smoking
- Diabetes mellitus
- Obesity
- Hypertension
- Hypercholesterolaemia
The 6p’s (acute limb ischemia signs and symptoms)
Pulseless
Paraesthesia
Pain
Paralysis
Pallor
Perishing cold
Investigations for acute limb ischemia
clinical diagnosis
You can roughly localise the blockage by locating thebifurcation distal to the last palpable pulse.
doppler to confirm absence of pulse
Mangement of acute limb ischemia
EMERGENCY
Thrombolytic agent
angioplasty
2 complications of acute limb ischemia
amputation
death
What is acute pericarditis
Inflammation of the pericardium
90% idiopathic or due to viral infections
Associated with systemic autoimmune disorders too
Acute vs chronic: 4-6 weeks vs >3 months
SS of acute pericarditis
Pleuritic central chest pain, worse on lying down, better sitting forward, intermittent fevers
Investigations for acute pericarditis
Examination: pericardial friction rub, tachycardia
ECG shows global upwardly concave ST-segment (J-point) elevations with PR segment depressions in most leads with J-point depression and PR elevation in leads aVR and V1
Mangement of acute pericarditis
Management: NSAIDs, can add colchicine.
- Corticosteroids
What is acute rheumatic fever
Rare but common in developing countries (major cause of death and heart disease)
Improvement in developed countries due to penicillin and improved social conditions and reduction in virulence of the GpA BHS
Autoimmune disease following a group A streptococcal infection.
Can affect joints, heart, brain, skin
Effects on heart can lead to permanent illness: chronic changes to heart valves referred to as chronic rheumatic disease
SS of acute rheumatic fever
Symptoms appear 1-5 weeks after sore throat
- Arthritis and toxicity with mild carditis (chest pain, SOB if severe), fever
- Palpitations, heart murmur, signs of heart failure
- Subcutaneous nodules/ erythema nodosum (swollen fat under skin causing red bumps and patches), chorea (jerky involuntary movements)
Investigation for acute rheumatic fever
Diagnosis based on Jones 2015 criteria
- Throat swabs, ESR, CRP, FBC. ECHO
Management for acute rhematic fever
Management: eradicate streptococcal infection, suppress inflammation, provide supportive treatment especially if complications such as HF
- Penicillin, aspirin, HF treatment if necessary cardiac surgery if treatment fails), diazepam if chorea present
what is angina
Pain/constricting discomfort in the chest
Radiating to the neck/shoulders/jaw/arms
Difference between stable and unstable angina presentation
Stable:
Occurs predictably
Lasting less than 15 mins, relieved by rest
with physical exertion or emotional stress
relieved within minutes of rest or GTN
unstable:
New onset or abrupt
often occurring at rest
lasts longer than 15 minutes
RF of angina
- smoking
- hyperlipidaemia
- age
- common in men but increases for women after menopause
- hypertension
- diabetes
- obesity
- exercise
- ethnicity
Pathophysiology of angina
Caused by an insufficient blood supply to myocardium
Atherosclerotic plaque inadequate oxygen to myocardium at times when oxygen demand increases (exercise)
SS of angina
chest pain
pain radiating to jaw neck and left arm
SOB
Dizziness
Investigation for angina
clinical history
Physical examination
blood test- rule out anaemia
ECG
Q-RISK
Management for angina (first line)
First line- Beta blocker or CCB, if both contraindicated or not tolerated then monotherapy with one of the following: nitrate, ivabradine, nicorandil, ranolazine
Management for angina (2 line)
Second line: if on B-blocker then add CCB. if on CCB then add b-blocker
Other management for angina
Aspirin
GTN
lifestyle advice
Primary prevention -> statins
secondary prevention-aspirin/clopidogrel, acei, statin, anti HTN
Complications of angina
Stroke
MI
Unstable angina
sudden cardiac death
anxiety
depression
draw the diagram outlining MI/NSTEMI/UNDTABLE ANGINGA
chest pain……. Non -cardiac
:
:
ACS ……….. STEMI (ST elevation)
:
:
Unstable angina/NSTEMI (ecg shows no st elevation)
:
:
if normal troponin levels, then = unstable angina
if raised troponin levels then NSTEMI
What is the initial 2 medication offered to NSTEMI and unstable patients (early management)
Antiplatelet - 300mg aspirin
Anti-thrombin - fondaparinux
STEMI early management
offer 300 mg of aspirin
assess eligibility for reperfusion therapy:
if yes offer PCI or fibrinolysis
if no proceed with medical management, offer ticagrelor with aspirin
5 post MI medications
ACEi
Clopidogrel
B-blocker
statin
rivaroxaban
2 things to do post MI
cardiac rehab and secondary prevention
What is angina pectoris: prinzmetal’s /variant
Coronary artery spasm
Common in patients with underlying heart disease but can occur in healthy people as well
Pathophysiology of angina pectoris: prinzmetal’s/ variant
- Not fully clear but is thought to be linked with low nitric oxide (secondary to reduced acetylcholine release), increased adrenergic activities, vasoconstrictor mediators (thromboxane, serotonin etc)
- Acetylcholine normally results in the release of nitric oxide and also act directly as a vasodilator at rest
- Thromboxane/serotonin are involved in platelet activation/recruitment. There is more of these mediators in prinzmetal
- Increased adrenergic activities can cause an increase in heart rate and peripheral vasoconstriction
RF for angina pectoris: prinzmetal’s/ variant
- Heart disease
- Stress
- Drugs such as cocaine, sympathomimetics such as epinephrine
- Alcohol
- Smoking
SS for angina pectoris: prinzmetal’s/ variant
- Rest chest pain common at midnight/morning and lasting between 5-30 minutes
- Headache
- Patient may have a history of coronary heart disease
- Deranged vital signs such as tachycardia, tachypnoea, high BP
- There might not be any focal cardiac examination finding unless patient has underlying heart disease
- Raynaud phenomenon if severe
Ix for ngina pectoris: prinzmetal’s/ variant
Bloods
- Most important blood test is Troponin to rule out ACS.
- FBC, renal function, electrolytes, fasting blood glucose and lipid levels
X-ray/Imaging
- CXR to rule out alternative causes
ECG
- STAT ECG might show transient STE. 24 hour ECG tape can be used if symptoms have resolved
Special Tests
- Coronary angiography is the investigation of choice. Other options include stress echocardiography
Management for angina pectoris: prinzmetal’s/ variant
- Lifestyle management
- Manage co-existing disease
- GTN/Calcium channel blockers are mainstay of medical treatment (avoid beta blockers as may aggravate symptoms)
- Revascularization
- coronary artery stenting
Complication for angina pectoris: prinzmetal’s/ variant
- Arrhythmias
- MI
What is aortic coarctation
congenital narrowing of the aorta
RF for aortic coarctation
- Men > Women
- Turner’s syndrome
- Aortic valve is bicuspid in 80% of cases
- Patent ductus arteriosus
- Ventricular septal defect
- Mitral stenosis/regurgitation
- Circle of Willis aneurysms
SS of aortic coarctation
asymptomatic
headaches and nose bleed to due to HTN
Claudication and cold legs
HTN in upper limbs
Week delayed pulse in legs
radio femoral delay
Ix for aortic coarctation
CXR
ECG
LVH
aortagraphy
CT/MRI
Management for aortic coarctation
Surgery
What is aortic stenosis
- Narrowing of the aortic valve
- Progressive disease
Pathophysiology of aortic stenosis
- Calcification of the valve is most common cause.
- Congenital, history of rheumatic heart disease
SS of aortic stenosis
- Can be asymptomatic for many years
- Shortness of breath with exertion, angina, syncope
- Systolic murmur, mid-to-late peaking with a crescendo-decrescendo pattern, radiates to carotids
- Can cause left ventricular hypertrophy, heart failure. Can lead to sudden cardiac death. Damaged valve prone to endocarditis
Ix for aortic stenosis
ECHO
Management of aortic stenosis
avoid heavy exertion, surgical intervention
What is aortic regurgitation
- Diastolic leakage of blood from the aorta into the left ventricle
- Acute :caused by endocarditis or aortic dissection
- Chronic: asymptomatic for years until symptoms of heart failure develop
Pathophysiology of aortic regurgitation
Caused by disease of the aortic valve (bicuspid aortic valve, rheumatic fever, infective endocarditis, collagen vascular disease, degenerative aortic valve disease) or aortic root
Acute SS of aortic regurg
Acute presents with sudden onset pulmonary oedema and hypotension/cardiogenic shock. May also present as myocardial ischaemia or aortic root dissection
chronic SS for aortic regurg
Chronic: initial symptoms can include palpitations and uncomfortable awareness of pounding heart when lying on left side
Management for aortic regurg
- Acute severe AR – urgent surgical intervention
- Chronic severe AR – goals of treatment to prevent death, diminish symptoms, to prevent development of hear failure and avoid aortic root complications
- Valve replacement
What is aortic aneurysm
Aneurysm is a bulge in the aorta
it can be abdominal (common) or thoracic
dissection is a tear
Aortic dissection can either be Type A (Ascending aorta) or Type 2 (Descending aorta)
Pathophys of aortic aneurysm
- Arteries are made up of three layers from proximal to distal namely tunica intima, tunica media and tunica adventitia
- Aortic aneurysm occurs when there is an irreversible degradation of the elastic lamellae (outermost part of the tunica intima) and associated smooth muscle loss
- Aortic dissection occurs when there is a damage to the tunica intima and blood pulls inside the tunica media
RF for aortic aneurysm
- Advanced age
- Hypertension
- Marfan syndrome
- Smoking
- Trauma
SS for aortic aneurysm
- Sudden ripping/tearing chest pain radiating to the back
- Shortness of breath
- Abdominal/back pain
- Asymmetric pulse
- Abdominal pain/distension
- Unequal blood pressure in both arms
- Abdominal bruit
- Flank haemorrhage
Ix for aortic aneurysm
Bloods
- FBC (Anaemia-although not immediately)
- Cross match
- LFT/RFT (to look for end organ ischaemic damage)
Orifice Test
- PR test when indicated
X-ray/Imaging
- CXR (can initially show widened mediastinum if thoracic aneurysm/dissection)
- CT-aortogram (widely used) or MRI angiography for confirmation
ECG
- Might show ischaemic changes like STE/STD depending where the dissection occurs
Special Tests
- If aneurysm/dissection in the context of trauma, A FAST scan can be done
Management for aortic aneurysm
- Lifestyle/risk factor management (stop smoking etc)
- Statin/Aspirin when indicated
- Further Medical management depends on the size of the aneurysm (Refer to secondary care)
- If between 3-4.4cm (Annual ultrasound), If 4.5-5.4 (3 monthly ultrasound), if >5.5cm (Immediate referral for surgery and 3 monthly ultrasound)
- There is a one off screening program for over 65s in england which can rule out aneurysm for life if negative
Complication for aortic aneurysm
- Cardiac tamponade
- Cardiogenic shock
What are arrythmias
Arrhythmias are abnormalities of the heart rate or rhythm caused by disorders of impulse generation or conduction.
What is atrial fibrillation
A supraventricular tachyarrhythmia with uncoordinated atrial electrical activation and consequently ineffective atrial contraction.
What is ECG finding of AFib
- Irregularly irregular R-R intervals(when atrioventricular conduction is not impaired)
- Absence of distinct repeating P waves
- Irregular atrial activations.
3 different classifications of Afib
Paroxysmal AF – episodes lasting longer than 30 seconds but less than 7 days (often less than 48 hours), that are self-terminating and recurrent
Persistent AF – episodes lasting longer than 7 days (spontaneous termination of the arrhythmia is unlikely to occur after this time) or less than seven days but requiring pharmacological or electrical cardioversion
Permanent AF – AF that fails to terminate using cardioversion, AF that is terminated but relapses within 24 hours, or longstanding AF (usually longer than 1 year) in which cardioversion has not been indicated or attempted
What is atrial flutter and its ECG characteristics
Flutter wave (instead of P waves) organize atrial depolarisations of a rate around 300bpm producing a saw-tooth pattern in typical counterclockwise flutter.
Narrow QRS complex
ECG finding for ventricular tachyarrhythmia
Irregular R-R interval
Risk factors for arrythmia
Middle aged - older adults
Europe and North America
Comorbidities
RF for Afib
age
comorbidities - HTN, diabetes, HF, CHD ,CKD
Obesity
Obstructive sleep apnoea
Pathophysiology of arrythmia
ischemic
degeneration
mitral stenosis
metabolic
Pathophysiology of Afib
Left atrial arrhythmia
often in the form of rapidly firing ectopic foci located inside one or more pulmonary veins, and an abnormal atrial tissue substrate capable of maintaining the arrhythmia.
SS of arrythmias
Breathlessness
Palpitations
Syncope/dizziness
Chest discomfort
Reduced exercise tolerance
Ix for arrythmias
Patient Hx
ECG recording
Ambulatory ECG monitoring
External loop recorders
Implantable Loop Recorders (ILR)
Signal average ECG
Structural heart imaging – Chest x-ray/Echo/MRI
Electrophysiology study
‘Personal smart-tech’
Blood count, electrolyte levels, drug levels, thyroid study
Afib investigation
The diagnosis of AF requires rhythm documentation with an electrocardiogram (ECG) tracing showing AF. By convention, an episode lasting at least 30 seconds is diagnostic for clinical AF.
if pulse is irregular then 12 lead ECG , Ambulatory ECG monitoring
Management for afib and atrial flutter
Urgent referral
-If the onset of atrial fibrillation (AF) was within the last 48 hours urgently and haemodynamic instability/loss of consciousness/severe dizziness or syncope/ongoing chest pain/increasing breathlessness.
Comorbidities and lifestyle
-assess for signs and symptoms and do test to confirm or rule out underlying causes of AF
Rate control
-beta blocker
-rate limiting calcium channel blocker
-digoxin
Stroke risk
Asses CHA2DS2VASC and HAS-BLED score
anticoagulant option-
DOACS
Rhythm control
-Pharmacological - anti arrhythmic drugs
- Intervention- PVI ablatio, pharmacological cardioversion and DCCV
Ventricular tachyarrhythmia management
Emergency – 999
Urgent – transfer ASAP to A&E monitored by a defibrillator and all monitoring/IV line if possible.
Complications for arrythmias
stroke
TIA
HF
What is arterial embolism/thrombosis
occlusion of arteries
- Most commonly affected arteries include those in the heart, brain, kidneys & lower limbs.
Pathophysiology of arterial embolism/thrombosis
- A thrombus is a local formation of clot while an emboli is a clot that has broken off to lodge in another area of the body
- Embolism/thrombosis occurs due to risk factors like lipidemia, cigarettes etc. These risk factors damage the vascular endothelium and consequently lead to arterial occlusion manifesting as ischaemia.
RF for arterial embolism/thrombosis
- Smoking
- Lipidemia
- Sedentary lifestyle
- Recent surgery
- Hypertension
- Obesity
- Atrial fibrillation
- Hypercoagulability states e.g thrombocytosis
SS for arterial embolism/thrombosis
- Pain
- Numbness/Tingling
- Muscle spasm/weakness
- Change in colour
- Skin coldness
- Checking CRT, pulse, sensation. All of which would be absent or delayed in peripheral vascular disease
Ix for arterial embolism/thrombosis
Bloods
- Lipids. ESR. HBA1c. Renal/Liver function tests. Creatine kinase, Troponin, FBC
X-ray/Imaging
- CT/MRI angiography. Arterial doppler. Echocardiogram
ECG
- Can show ischaemic picture if heart involved
Special Tests
- Ankle brachial pressure index
Management for arterial embolism/thrombosis
- Urgent admission and anticoagulation should be started immediately.
- Surgical embolectomy or intra-arterial thrombolysis if occlusion is from embolus
- Angioplasty or bypass surgery or thrombolysis
- Managing risk factors/comorbidities e.g smoking, lipidemia
Complication for arterial embolism/thrombosis
- Necrosis/Gangrene
- Chronic pain syndrome
What is atrial septal defect
Communication between the left and right side of the heart
hole in the septum that divides the atrial wall chambers
SS for atrial septal defect
Asymptomatic in infants and children
Subtle SOBOE/palpitations in second decade of life
Adults with large defect → fatigue, exercise intolerance, palpitations, syncope, SOB, peripheral oedema, thromboembolic manifestations, and cyanosis
Ix for atrial septal defect
Widely split second heart sound. Soft systolic ejection murmur
ECHO
Management for atrial septal defect
Diuretics for those that develop heart failure. Surgical closure
What is AV block and what are 4 subtypes called
Atrioventricular (AV) block (often referred to as “heart block”) involves the partial or completeinterruption of impulse transmission from theatria to theventricles
sub-types of AV blockincluding:
- First-degree AV block
- Second-degree AV block (type 1)
- Second-degree AV block (type 2)
- Third-degree (complete) AV block
ECG finding for first degree heart block
- Rhythm: regular
- P wave: every P wave is present and followed by a QRS complex
- PR interval: prolonged >0.2 seconds (5 small squares)
- QRS complex: normal morphology and duration (<0.12 seconds)
ECG finding for second degree type 1 heart block
Second-degree AV block (type 1) is also known asMobitz type 1 AV block orWenckebach phenomenon
ECG:
- Rhythm: irregular
- P wave: every P wave is present, but not all are followed by a QRS complex
- PR interval: progressively lengthens before a QRS complex is dropped
- QRS complex: normal morphology and duration (<0.12 seconds), but are occasionally dropped
ECG finding for second degree type 2 heart block
Second-degree AV block (type 2) is also known asMobitz type 2 AV block
ECG:
- Rhythm: irregular (may be regularly irregular in 3:1 or 4:1 block)
- P wave: present but there are more P waves than QRS complexes
- PR interval: consistent normal PR interval duration with intermittently dropped QRS complexes
- QRS complex: normal (<0.12 seconds) or broad (>0.12 seconds)
- The QRS complex will be broad if the conduction failure is located distal to the bundle of His
ECG finding on a third-degree heart block
there isno electrical communication between the atria and ventricles due to acomplete failure of conduction
ECG:
- Rhythm: variable
- P wave: present but not associated with QRS complexes
- PR interval: absent (as there is atrioventricular dissociation)
- QRS complex: narrow (<0.12 seconds) or broad (>0.12 seconds) depending on the site of the escape rhythm (see introduction)
RF for 1 degree HB
often in athletes
post MI
Lyme disease
Congenital
RF for 2 degree t1 HB
- Increased vagal tone: often seen in athletes (non-pathological)
- Drugs: beta-blockers, calcium channel blockers, digoxin, amiodarone
- Inferior myocardial infarction
- Myocarditis
- Cardiac surgery (mitral valve repair, Tetralogy of Fallot repair)
RF doe 2 degree T2 HB
- Myocardial infarction
- Idiopathic fibrosis of the conducting system (Lenegre’s or Lev’s disease)
- Cardiac surgery (especially surgery occurring close to the septum such as mitral valve repair)
- Inflammatory conditions (rheumatic fever, myocarditis, Lyme disease)
- Autoimmune (SLE, systemic sclerosis)
- Infiltrative myocardial disease (amyloidosis, haemochromatosis, sarcoidosis)
- Hyperkalaemia
- Drugs (e.g. beta-blockers, calcium channel blockers, digoxin, amiodarone)
- Thyroid dysfunction
RF 3 degree HB
- Congenital: structural heart disease (e.g transposition of the great vessels), autoimmune (e.g maternal SLE)
- Idiopathic fibrosis: Lev’s disease (fibrosis of the distal His-Purkinje system in the elderly) and Lenegre’s disease (fibrosis of the proximal His-Purkinje system in younger individuals)
- Ischaemic heart disease: myocardial infarction, ischaemic cardiomyopathy
- Non-ischaemic heart disease: calcific aortic stenosis, idiopathic dilated cardiomyopathy, infiltrative disease (e.g. sarcoidosis, amyloidosis)
- Iatrogenic: post-ablative therapies and pacemaker implantation, post-cardiac surgery
- Drug-related: digoxin, beta-blockers, calcium channel blockers, amiodarone
- Infections: endocarditis, Lyme disease, Chagas disease
- Autoimmune conditions: SLE, rheumatoid arthritis
- Thyroid dysfunction
SS for 1 degree H block
asymptomatic
SS for 2 degree t1 H block
often asympto but can develop bradycardia and syncope, irregular pulse
SS for 2 degree t2 H block
Palpitations, Pre-syncope, Syncope, regular irregular pulse
SS for 3 degree H block
- Palpitations
- Pre-syncope/syncope
- Confusion
- Shortness of breath (due to heart failure)
- Chest pain
- Sudden cardiac death
Ix for AV block
ECG
Management for AV block
Stop any AV blocking drugs
if symptomatic then pacemaker
from second t2 onwards place on cardiac monitor as a result of risk of complete AV block
third degree: cardiac monitor, transcutaneous pacing/temporary pacing wire
orisoprenaline infusion, pacemaker
Complication for the different AV block subtype
First deg→ afib
Second deg T1 → haemodynamically compromised
second T2- complete AV block
third→ sudden cardiac death
What is bbb
A bundle branch block is a condition in which there is a delay or blockage along the pathway that electrical impulses travel to make a heartbeat.
The delay or blockage can occur on the pathway that sends electrical impulses either to the left or the right side of the bottom chambers (ventricles) of your heart.
Bifascicular → involves both right bundle branch block as well as blockade of one of the fascicles of the left bundle branch.
Trifasicular → is present when 3rd degree heart block exists along bifasicular block
Pathophysiology of BBB
A bundle branch block is a condition in which there is a delay or blockage along the pathway that electrical impulses travel to make a heartbeat.
The delay or blockage can occur on the pathway that sends electrical impulses either to the left or the right side of the bottom chambers (ventricles) of your heart.
Bifascicular → involves both right bundle branch block as well as blockade of one of the fascicles of the left bundle branch.
Trifasicular → is present when 3rd degree heart block exists along bifasicular block
RF FOR lbbb
Dilated Cardiomyopathy (the main cause of LBBB) Left ventricular hypertrophic cardiomyopathy (LBBB) HTN
MI myocarditis
RF for RBBB
RBBB Thin tall young people
MI myocarditis
SS for BBB
asymptomatic
underlying cause symptoms like MI with chest pain or SOB
ECG criteria for RBBB
- MarRoW
- QRS > 120 ms (3 small squares)
- RSR’ pattern in V1-V3
- Wide, slurred S wave in lateral leads – I, aVL, V5-V6
ECG criteria for LBBB
- WiLliaM
- QRS duration > 120ms (3 small squares)
- Dominant S wave in V1
- Broad, monophasic R wave in lateral leads – I, aVL, V5-V6
- Absence of Q waves in lateral leads
- Prolonged R wave > 60ms in leads V5-V6
Management for BBB
Patient based
treat any underlying cause
if hx of syncope due to it then pacemaker
Complication for BBB
- Complete heart block
- Ventricular tachycardia
- Ventricular fibrillation
What is cardiac tamponade
Accumulation of blood, fluid, pus, clots, or gas in pericardial space
Results in reduced ventricular filling and reducing cardiac output and subsequent haemodynamic compromise
Often: pericardial effusion cardiac tamponade
- Iatrogenic (cardiac surgery/intervention), trauma, malignancy, idiopathic effusion, viral, radiation, uraemia
SS of cardiac tamponade
Dyspnoea, tachycardia and tachypnoea cold and clammy extremities
Distended neck veins, hypotension tachycardia, tachypnoea and hepatomegaly
Mangement for cardiac tamponade
Medical emergency!
emergency. Managed in ITU. Pericardiocentesis is definitive treatment
What is cardiomyopathy
Myocardial disorder
Heart muscle is structurally and functionally abnormal
Without CAD, HTN, Valvular or congenital heart diseases.
Degree of dysfunction ranges from lifelong symptomless forms to major health problems, such as progressive heart failure, arrhythmia, thromboembolism and sudden cardiac death.
What are the 4 major types of cardiomyopathies
- Dilated cardiomyopathy
- Hypertrophic cardiomyopathy
- Restrictive cardiomyopathy
- Arrhythmogenic right ventricular cardiomyopathy (ARVC)
Primary vs secondary cardiomyopathy
Primary: Idiopathic. No specific cause.
Secondary: chronic kidney disease, cirrhosis, obesity, sarcoidosis, amyloidosis, SLE, diabetes, thyroid disease, thiamine deficiency, etc
Management for cardiomyopathy
- Symptomatic management
- Mainly directed towards treatment of heart failure and prevention of VTE and sudden death
- Implantable cardioverter defibrillators in high risk patients to prevent sudden death
- Surgical myectomy/ alcohol septal ablation
- Heart transplant
What is coronary artery disease
- Narrowing of the coronary arteries which leads to heart problem
- Narrowing can occur as a result of blood clot or atherosclerosis
- complete blockage leads to heart muscles dying leading to MI
- Coronary flow occurs during diastole
RF for CHD
- smoking
- unhealthy diet (hyperlipidaemia)
- age
- common in men but increases for women after menopause
- hypertension
- diabetes
- obesity
- exercise
- ethnicity
Pathophysiology of CHD
atherosclerosis
SS for CHD
angina
cold sweats
dizziness
neck pain
shortness of breath
Ix for CHD
ECG
Echocardiogram
stress test
Management for CHD
Immediate management - ABCDE
atorvastatin
Warfarin
beta blocker
ACEi
ARB
What does MONARCH stand for in CHD Management
Morphine
Oxygen
Nitrates
Aspirin 300mg
Reperfusion PCI
Clopidogrel/Ticagrelor
Heparin or LMWH
Complication for CHD
angina
MI
HF
Stroke
anxiety
reduced qualy