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ESA2 > CVS S10 - Ischaemic Heart Disease > Flashcards

CVS S10 - Ischaemic Heart Disease Flashcards

0
Q

Give examples of conditions originating in the lungs and pleura which can cause chest pain

A

Pneumonia
Pneumothorax
Pulmonary embolism

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1
Q

What are the general common sources of chest pain?

A

Lungs & Pleura
GI system
Chest wall
CVS - heart & great vessels

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2
Q

Give examples of conditions originating in the GI system which can cause chest pain

A

Oesophagus (reflux)
Peptic ulcer disease
Gall bladder (cholecystitis, biliary colic)

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3
Q

Give examples of conditions originating in the chest wall which can cause chest pain

A

Fractured ribs
Muscles
Skin

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4
Q

Give examples of conditions originating in the CVS which can cause chest pain

A

Myocardium - angina, MI
Pericardium - pericarditis
Aorta - aortic dissection

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5
Q

Give some non-modifiable risks for coronary atheroma (and by extension, IHD)

A

Increasing age
Gender
Genetics (family history)

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6
Q

Give some modifiable risks for coronary atheroma (and by extension, IHD)

A 
Hyperlipidaemia
Smoking
Hypertension
Diabetes mellitus
Exercise
Obesity
Stress
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7
Q

Describe ischaemic chest pain

A

Central, retrosternal or left-sided
Described as crushing, tightening, heavy, constricting
Can radiate along jaw, arm, neck and back (particularly left side of all)

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8
Q

Is IHD-caused chest pain always the same?

A

Can be different in different people
Can have radiation or not, can be only referred pain, can vary in intensity, duration, precipitating and relieving factors

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9
Q

Describe stable angina

A

Mild to moderate IHD chest pain brought on by exertion or emotion, particularly after meals or in cold weather
Relieved by rest
Occurs when >70% of the lumen of a coronary artery is occluded by an atheromatous plaque

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10
Q

How is angina treated?

A

Acutely: sub-lingual GTN spray
Preventatively: beta blockers, Ca channel blockers, oral nitrates
Preventing cardiac events: aspirin, statins, ace inhibitors
Long term: consider revascularisation

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11
Q

Describe unstable angina

A

Ischaemic chest pain which occurs at rest or with minimal exertion. Described as severe and as having a crescendo pattern (becoming distinctly more severe, prolonged or frequent than before)
Caused by worsened stable angina as plaques grow and more coronary lumen is occluded

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12
Q

How would a patient with an MI present?

A

With very serious ischaemic chest pain at rest
Not alleviated by rest or GTN spray
May have no precipitant
Autonomic features eg sweating pallor nausea vomiting
Breathlessness and fainting due to LV dysfunction

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13
Q

How does a myocardial infarction occur?

A

Complete occlusion of a coronary artery leads to ischaemia and infarction of the myocardium it supplies
The fibrous cap of an atheromatous plaque can erode or fissure, allowing blood to the necrotic core & causing thrombus formation which can completely occlude a coronary artery

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14
Q

What are the two general categories of myocardial infarction?

A

STEMI

NSTEMI

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15
Q

Describe a STEMI

A

A myocardial infarction where the ST wave on an ECG is elevated, leading to the abbreviation (ST Elevated Myocardial Infarction)
Occurs when the infarct is the full thickness of the myocardium

16
Q

Describe a NSTEMI

A

An MI where the ST wave of an ECG is not elevated

Occurs when the infarct is not the full thickness of the myocardium

17
Q

Discuss the diagnosis of angina

A

ECG is usually normal so an exercise stress test is used
Diagnosis is based on history so these may contribute to diagnosis:
High BP
Corneal arcus
Evidence of atheroma elsewhere eg peripheral vascular disease
LV dysfunction

18
Q

Describe an exercise stress test

A

Graded exercise whilst connected to an ECG until:

  • Target heart rate reached
  • Chest pain
  • ECG changes
  • Other problems (arrhythmia, low bp, ect)
19
Q

What constitutes a positive exercise stress test result for diagnosis of angina?

A

ST depressions of >1mm

20
Q

What is acute coronary syndrome?

A

A group of symptoms attributed to the obstruction of coronary arteries as a result of NSTEMI, STEMI or unstable angina

21
Q

How can an unstable arrhythmia be differentiated from an NSTEMI?

A

UA has no myocardial necrosis whereas NSTEMI has some
So UA would have no bio markers like troponin in the blood but an NSTEMI would have a small amount
In an ECG, there may or may not be a difference

22
Q

How can a STEMI be differentiated from an NSTEMI?

A

An NSTEMI has partially occluded coronary arteries whereas a STEMI would have complete occlusion
A STEMI would also have significantly more necrosis than an NSTEMI so significantly more troponin and CK bio marker release
On an ECG, a STEMI would show ST elevation but NSTEMI wouldn’t

23
Q

What does a deep or pathological q wave indicate?

A

A previous myocardial infarction which has since healed

24
Q

What troponin isotopes are looked for in suspected MI? Discuss timescales of appearance

A

Cardiac troponin I (cTnI) and T (cTnT)
Rise 3-4h after onset of ischaemic chest pain
Peak 18-36h after
Slowly decline over the next 10-14 days

25
Q

What creatine kinase isotopes are looked for in suspected MI? Discuss timescales of appearance

A

CK-MB is the cardiac iso-enzyme
Rises 3-8h after onset of ischaemic chest pain
Peaks after 24h
Returns to normal in 48-72h

26
Q

Give examples of bio markers seen in the blood after an MI

A 
Troponin (types I and T)
Creatine kinase (the MB isoenzyme)
27
Q

What does presence of CK-MB, cTnI or cTnT in the blood indicate?

A

There has been death of myocardium

28
Q

How may progression of thrombosis be achieved?

A

Anti platelet agents eg aspirin

Anticoagulants eg heparin

29
Q

How may perfusion be restored to partially occluded vessels?

A

Early percutaneous coronary intervention (PCI) aka angioplasty
Coronary artery bypass graft (CABG)

30
Q

What medications are used in ischaemic heart disease?

A 
ACE-inhibitors
Beta-blockers
Statins
Organic nitrates
Pain control
Oxygen
31
Q

Describe an angiography

A

Can be used to view any vessel occlusions

The findings of this procedure may be used to make choices about revascularisation surgeries

32
Q

Describe percutaneous coronary intervention (PCI)

A

Angioplasty and stenting
A balloon is inflated in the occluded vessel to increase lumen diameter
A mesh stent is expanded simultaneously, which holds the vessel open

33
Q

Describe coronary bypass grafting

A

Involves taking a blood vessel from elsewhere in the body eg internal mammary artery, radial artery, reversed saphenous vein
This vessel is then grafted onto the heart to provide blood flow around an occlusion

34
Q

Give the typical presentation of acute pericarditis

A

Central or left-sided chest pain
Sharp pain which is worse on inhalation
Pain is relieved by leaning forward

35
Q

What can cause acute pericarditis?

A 
Infection (viral, TB)
Post MI or cardiac surgery
Autoimmune
Uraemia (kidney failure)
Malignant deposits

ESA2 (39 decks)

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