IHD 1 - overview Flashcards
What are 2 other names interchangeable with ischaemic heart disease?
Coronary artery diseaseCoronary heart disease
What is ischaemic heart disease?
When the coronary artery blood flow becomes restricted secondary to an accumulation of atherosclerotic plaque (myocardial ischaemia may be less frequently reduced due to other conditions such as coronary arterial spasm)
When does ischaemia occur?
When myocardial oxygen demand exceeds supply, often presenting as chest pain
Difference between ischaemia and infarction?
Ischaemia = reduced blood supplyInfarction = cell death due to ischaemia
What is sudden cardiac death (SCD)?
Sudden cardiac arrest with no warning or within 1 hour of onset of symptoms
What are 3 things that have been associated with IHD presenting with SCD?
Familial trait with sudden death as first manifestation of IHDAssociation between long QT interval and SCD in IHDIncidence is much higher in patients who have had runs of VT post MI
What is a heart attack (MI)?
Death of heart muscle tissue due to loss of blood supply
What causes death due to an MI? (2)
Arrhythmias - commonly VFSeverely damaged heart muscle
What is ischaemic cardiomyopathy?
A type of dilated cardiac myopathy caused by narrowing of the coronary arteries. In this condition the heart muscle is weakened. In this condition, the left ventricle, which is the main heart muscle, is usually enlarged and dilated.
What can an unstable plaque lead to?How does this lead to SCD?
Transient ischaemiaDuring repercussion, there is lengthening of the time course of depolarisation = long QT which can lead to the formation of arrhythmias and cardiac arrest
What is cardiogenic shock?
Inadequate systemic perfusion as a result of cardiac dysfunction
What is angina?
Clinical manifestation of myocardial ischaemia which is typically characterised by central crushing chest pain on exertion that is relieved by rest
Where can pain from angina be felt? (5)
Radiating to arm(s), back, neck, jaw, teeth
What are some examples of angina triggers? (4)
ExertionStressCold windAfter meals
Some GI tract problems which could be a differential diagnosis of chest pain?
RefluxPeptic ulcer painOesophageal spasmBiliary colic (unusual to be confused with angina)
Differential diagnosis for chest pain? (4)
GI tract e.g. reflux, oesophageal spasmMusculoskeletalPericarditisPleuritic pain
What is angor animi?
Symptom defined as a patient’s perception that they are dying
3 emergency conditions that can cause chest pain?
MIPEDissection of aorta (tearing, excruciating, severe then eases)
How is angina usually diagnosed?
Clinical diagnosis
Can patients have coronary artery disease without angina?Can patients have angina without coronary artery disease?
A patient can have coronary artery disease without angina or angina without coronary artery disease
What is an alternative to an exercise ECG looking for coronary artery disease in less mobile patients?
Myocardial perfusion imaging
4 possible tests to look for coronary artery disease?
Exercise ECGMyocardial perfusion scanCT angiographyAngiography
What are some of the problems caused by the contrast used in angiography? (3)
Renal dysfunctionRashNausea
What is the difference between angiography and CT angiography?
In angiography dye is injected into the blood vessels and a series of images are taken (more invasive but more reliable)In CT angiography is basically a CT scan that looks at the blood vessels after dye is injected (non-invasive but less precise especially if calcium present)
Relieving symptoms of IHD?
DrugsLifestyle (smoking, exercise, diet)Revascularisation (CABG, PCI)
What is the purpose of beta blockers?
Slow heart rate reducing O2 demand
What vessels tend to be grafted during coronary artery bypass surgery?
Long saphenous vein (leg)Internal mammary (thoracic) artery (supplies anterior chest wall)
Cardioplegia?
Intentional and temporary cessation of cardiac activity
What can patients experience 8-10 years after getting a coronary artery bypass graft?
Graft disease
Complications of CABG?
DeathStrokeMIAtrial fibrillationInfectionCognitive impairmentSternal malunionRenal failure
What is pre-cutaneous coronary intervention?
a non-surgical procedure that uses a catheter (a thin flexible tube) to place a small structure called a stent to open up blood vessels in the heart that have been narrowed by plaque buildup
What are the complications of PCI?
DeathStrokeMIRenal failureBleedingVascular complicaitonsStent thrombosisStent restenosis (section of artery opened up by stent re-closes again)Might need to perform emergency CABG
How is PCI carried out?
Vascular access is made and anti-playlet/ anti-coagulation drugs are givenA catheter is passed to the osmium of the coronaryGuidewire is passed down the vesselBalloons threaded over wire and stent implantedBalloon, catheter and wires removed
What is coronary angioplasty?
means using a balloon to stretch open a narrowed or blocked coronary artery (stent is usually placed)Angioplasty with a stent = PCI
What is angiography?
Radiology of blood or lymph vessels
When is revascularisation carried out for angina?
If the has severe symptomsIf the patient is high risk of having an MI e.g. multi-vessel disease, left main disease, diabetes, co-morbidities
What is Euroscore?
A method of calculating predicted operative mortality for patients undergoing cardiac surgery.
What are 2 specific problems related to carrying out PCI?
Dual antiplatlet therapyVascular access
Advantages of using the radial artery as access for PCI?
Dual supply to handSuperficialNo adjacent nerve/vein
Disadvantages of using the radial artery for access for PCI?
SmallerProne to spasmAsymptomatic occlusion 5%
Haematoma?
Localised collection of blood outside the blood vessels
Does primary PCI or thrombolysis have fewer side effects?
Primary PCI
