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IHD Flashcards

1
Q

Define ischaemic heart disease

A

Decreased perfusion or increased demand to the heart

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2
Q

Non-modifiable RFs

A

Male, post-menopausal female

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3
Q

Age range to be considered SIGNIFICANT FHx?

A

Males

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4
Q

Co-morbidities as RFs

A

CKD
HT
DM
Obesity/hyperlipidaemia

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5
Q

Lifestyle factors as RFs

A

Smoking
Obesity, diet, sedentary lifestyle
Stress
Depression

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6
Q

Top 4 triggers of ischaemic event

A 
ECEM
Exercise
Cold Air
Emotions
Meals
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7
Q

Some medical triggers of ischaemic event

A

Anaemia
Infection
Thyroid

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8
Q

RFs/Causes of atherosclerosis

A

Hypertension
High LDL
Smoking
DM

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9
Q

Process of atherosclerosis

A
  1. Endothelial injury
  2. LDL monocytes and platelets adhere and enter endothelium
  3. Macrophages ingest LDL to form foam cells
  4. Foam cells accumulate and form fatty streaks in intima
  5. Cytokines/growth factors cause Smooth Muscle migration into intima
  6. Formation of fibrous cap, which can calcify
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10
Q

Cells that migrate into intima during atherosclerosis

A

LDL monocytes, platelets, lymphocytes, macrophages, smooth muscle

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11
Q

Percent occlusion that is bad and when collaterals develop

A

70%

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12
Q

Percent occlusion that is serious and can cause resting myocardial flow impairment

A

90%

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13
Q

Inferior MI may be caused by occlusion of?

A

RCA, LCs

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14
Q

Anteroseptal MI may be caused by occlusion of?

A

LAD

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15
Q

Posterior MI may be caused by occlusion of?

A

LCx

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16
Q

Anterolateral MI may be caused by occlusion of?

A

LCA

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17
Q

Pathology immediately after MI?

A

No significant change

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18
Q

Pale, acute inflammation, necrosis (striations disappear)

A

Pathology 24-28h after MI

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19
Q

Yellow rubbery centre with hemorrhagic border, obvious necrosis and inflammation, early granulation at periphery

A

Pathology 3-4 days after MI

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20
Q

Area of infarction progressively replaced by granulation tissue

A

Pathology 10 days after MI

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21
Q

Paler and thinner fibrous tissue

A

Pathology 1-3 weeks after MI

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22
Q

Silvery fibrous scar tissue

A

Pathology 3-8 weeks after MI

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23
Q

Acute Coronary Syndrome (ACS) encompasses which conditions?

A

Unstable angina
NSTEMI
STEMI

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24
Q

Define NSTEMI

A

Partial thickness damage, no ST elevation seen on ECG

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25
Aetiology of NSTEMI
Complete occlusion of minor artery OR Partial occlusion of major artery
26
Define STEMI
Full thickness damage, ST elevation seen on ECG
27
Aetiology of STEMI
Complete occlusion of major artery
28
Troponins are negative in which IHD conditions
Angina (stable, unstable)
29
Troponins are positive in which IHD conditions
NSTEMI, STEMI
30
How long post-Sx do Trops begin rising?
4-8h
31
How long post-Sx do Trops peak?
18-24h
32
How long post-Sx do Trops remain elevated for?
6-10days
33
How long post-Sx does CK start rising?
4-6h
34
How long post-Sx does CK remain for until which it drops?
1-3 days
35
Central chest pain, crushing, pressure, dull, radiating to L/R arm, jaw, shoulder SoB Diaphoresis/sweating Impending sense of doom
Classic features of AMI
36
AMI with bradycardia and vomiting
Inferior MI (RCA, vagus nerve affected??)
37
Patient groups at high risk of silent MI
Women Elderly Diabetics
38
Breathlessness, confusion, drop in arterial pressure, arrhythmia, no pain
Silent MI
39
ST elevation that is significant (mm)
Chest leads 2mm | Limb leads 1mm
40
How often to do Trops
After 0, 3 and 6 hours
41
Acute Rx of stable angina
Nitrates - take sitting down, 3 puffs, if persists then call ambulance
42
Rx to relieve angina
Sublingual Glyceryl TriNitrate (GTN)
43
Rx to prevent angina Sx
B-blocker Central Ca2+ (verapamil, diltiazem) Long acting nitrate
44
Emergency Rx of AMI!
MONA: Morphine (2.5-5mg IV single dose) O2 (SaO2
45
Pharmaco Rx of confirmed STEMI/NSTEMI
1. Antiplatelet: aspirin/clopidogrel 2. Anticoagulation: heparin/LMWH 3. B-blocker or Central CCB
46
Time limit after Sx of STEMI for PCI (angioplasty + stent)
70-90min
47
For STEMI, If no access to PCI, then use
Thrombolysis (tPA - tissue plasminogen activator aka alteplase)
48
Rx of confirmed NSTEMI
Aggressive anti-platelet meds
49
3 types of PCI interventions
Balloon angioplasty Bare metal stent Drug-eluting stent
50
Post-AMI secondary prevention consiste of which 4 drugs
``` SAAB Statin Aspirin ACE-i B-blocker ```
51
Post AMI - what is the % risk of another AMI?
25%
52
Immediate post-MI complications?
Contractile dysfunction Cardiac arrhythmias Papillary muscle dysfunction --> valve regurgitation --> cardiac failure
53
After how many days does post-MI pericarditis occur?
2-3 days
54
After how many days does post-MI myocardial rupture occur?
4-5 days when there is maximal necrosis
55
Mural thrombosis or PE occurs how many weeks post-MI?
2 weeks
56
What are some late complications of MI?
ventricular aneurysm, arrhythmias, Dressler's syndrome (weeks-months).
57
What is Dressler's syndrome?
A type of pericarditis caused by the immune response to damaged cardiac tissue.
58
Chest pain, fever, pericardial effusion, high ESR
Sx of Dressler's syndrome
59
Rx of Dressler's syndrome?
Corticosteroids
60
Why may patients with AMI have a new S4?
Myocytes fail to take Ca2+ from cytoplasm into the sarcoplasmic reticulum, hence heart muscle becomes stiff
61
Autosomal dominant, 1 in 500, deficiency of LDL receptors --> impaired clearance of LDL from circulation --> raised LDL.
Heterozygous familial hypercholesterolaemia (HFH)
62
Isolated hypercholesterolaemia FHx of early AMI Corneal arcus (esp if
Heterozygous familial hypercholesterolaemia (HFH)
63
6 secondary causes of hyperlipidaemia?
``` Hypothyroidism Chronic liver disease Nephrotic syndrome Diabetes Excess alcohol Drugs: thiazides, anabolic steroids (^ total cholesterol, v HDL) ```
64
SE of statins?
``` Abnormal LFTs Muscle aches (myositis, rhabdomyolysis) ```
65
well-built 30yo man with raised total cholesterol but decreased HDL
Anabolic steroid abuse
66
Normal total cholesterol levels

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