CVS Session 10- Chest Pain And IHD Flashcards
What are the three respiratory causes of chest pain?
Pneumothorax
Pneumonia
Pulmonary embolism
What are the 2 GI causes of chest pain?
Acid reflux
Gallbladder- cholecystitis
What are the 3 musculoskeletal causes of chest pain?
Fracture/trauma to ribs
Muscle pain
Bone metastases
When does flow occur?
During diastole
When does myocardial Ischaemia occur?
When the supply cannot meet the oxygen demand of the myocardium
What is the most common cause of ischaemic heart disease?
Atheromatous coronary artery disease
What are the 3 non-modifiable risk factors of coronary artery disease?
Family history
Increasing age
Gender
What are the 4 main modifiable risk factors of coronary artery disease?
Diabetes
Hypertension
Hyperlipidaemia
Smoking
Describe an Atheromatous plaque.
It has a necrotic centre with a fibrous cap.
What is the result of an unstable plaque rupture?
It causes blood to be exposed, platelets to aggregate and fibrin to form a clot. This forms a thrombus which reduces the lumen size, decreases blood flow and causes Ischaemia.
What is the difference between stable and unstable angina?
Stable angina resolves after a few minutes with rest, where as unstable angina doesn’t and occurs during rest.
What 3 factors trigger stable angina?
Exercise
Cold
Meals
Is there myocyte injury or necrosis in stable angina?
No
What two factors relieve stable angina?
Nitrate spray
Rest
What can be seen in the ECG of someone with stable angina:
a. At rest
b. Upon exertion
a. Normal ECG trace
b. ST depression
What are the two aims of treatment of stable angina?
Increase blood flow
Reduce myocardial oxygen demand
What are 3 treatments of stable angina that lower the myocardial oxygen demand? How do they do this?
Beta blockers- reduce the HR and contractility
Calcium channel blockers- cause peripheral vasodilatation and therefore reduce the after load
Nitrates- cause venodilation and therefore reduce the preload
What are the 3 treatments of stable angina that increase blood flow? How do they do this?
Aspirin- Decrease platelet aggregation and therefore thrombus formation
Statins- reduced LDL cholesterol and therefore prevent further atherosclerosis
Revascularisation
What is acute coronary syndrome the result of?
Coronary artery occlusion
What is a STEMI?
A myocardial infarction with ST elevation that is the result of a complete occlusion of the coronary artery and consequent Ischaemia and myocardial necrosis.
What is NSTEMI?
It is a myocardial infarction without ST elevation. It is a partial occlusion of a coronary artery that doesn’t result in myocardial necrosis.
What is unstable angina?
It is a progression of stable angina because of atheroma progression, that occurs during rest.
What are the similarities between NSTEMI and unstable angina? (2)
Partial occlusion of coronary artery by thrombus
ST depression
What distinguishes between NSTEMI and unstable angina?
The prescence of cardiac biomarkers in the blood.
NSTEMI has troponin present, unstable angina doesn’t.
What is an exercise stress test and when is it used?
It is used when stable angina is an uncertain diagnosis following a history being taken.
The patient is hooked up to an ECG machine and a blood pressure cuff.
They stand on a treadmill and there is a gradual increase in exercise until:
-the target heart rate is reached
-chest pain occurs
-other problems occur
-ECG changes occur
What is a myocardial infarction?
A complete occlusion of a coronary vessel that causes an infarct/death of myocardium.
What are signs and symptoms of an MI? (7)
- central crushing chest pain
- nausea
- pallor
- sweating
- vomiting
- fainting
- breathlessness
What are the two biochemical markers that can be detected in the blood to distinguish between and NSTEMI and unstable angina?
Troponin Creatine kinase (MB)
What is the preferred treatment for a STEMI?
Percutaneous coronary intervention (PCI) - blow up a balloon inside a vessel so that the plaque is compressed. Insert a meshwork to keep the vessel dilated.
What are the two methods of Revascularisation?
Percutaneous coronary intervention (PCI)
Coronary artery bypass grafting (CABG)
What are the two groups of drugs given to treat NSTEMIs and unstable angina? Give an example of each.
- anticoagulants - heparin
- anti-platelet agent - aspirin
What are 5 causes of acute pericarditis?
- infection
- post MI/ cardiac surgery
- autoimmune
- uraemia (kidney failure)
- malignant deposits
What are 3 symptoms of acute pericarditis?
- central/left sided chest pain
- sharp, worse with inspiration
- improved by leaning forwards
What are the three cardiovascular causes of chest pain?
Pericarditis
Myocardium- angina, MI
Aorta- aortic dissection
