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Cardiology > IHD > Flashcards

IHD Flashcards

1
Q

Define IHD?

A

decreased blood supply to myocardium resulting in chest pain (angina pectoris)

primarily due to atherosclerosis of the coronary arteries resulting in O2 not sufficient for demand

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2
Q

summarise the branches of IHD?

A
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3
Q

what are the risk factors for IHD?

A

Hypertension

Smoking

Diabetes

Family History

Previous Medical History

Hyperlipidaemia

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4
Q

what are the signs of hyperlipidaemia?

A

corneal arcus

xanthelasma

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5
Q

Define stable angina?

A

Chest pain brought on during exertion and relieved by rest due to myocardial ischaemia most often from atherosclerotic plaques

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6
Q

what is seen on examination in stable angina?

A

normal examination in chronic stable angina

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7
Q

what are the investigations for IHD?

A

Bloods –inclipids, FBC, glucose

ECG

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8
Q

what is the conservative mangement for stable angina?

A
  • Weight loss
  • Improved diet
  • Smoking cessation
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9
Q

what is the medical management for stable angina?

A
  • Drugs:
  • ACEi
  • Antiplatelet (aspirin)
  • Statins
  • Anti-anginals(beta-blocker/calcium-channel blocker)
  • GTN spray
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10
Q

describe the vessel in stable angina and describe the ECG and trop?

A

angina develops when there is increased demand in setting of a stable atherosclerotic plaque

ECG- normal

trop- normal

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11
Q

describe the vessel in unstable angina, the ECG and trop?

A

plaque ruptures and a thrombus forms around the ruptured plaque causing occlusion of the vessel

angina pain occurs at rest or progresses rapidly over short period of time

ECG- normal, inverted T waves, or ST depression

trop- normal

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12
Q

describe the vessel in a NSTEMI, ECG and trop?

A

plaque rupture and thrombus formation causes partial occlusion of vessel-> results in injury and infarct to subendocardial myocardium

ECG- normal, inverted T waves, ST depression

trop- elevated

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13
Q

describe the vessel in a STEMI, the ECG and trop?

A

complete occlusion of blood vessel lumen-> results in transmural injury and infarct to myocardium-> reflected in ECG changes and rise in troponins

ECG- hyperacute t waves or ST elevation

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14
Q

define ACS?

A

Range of condition due to sudden reduction in blood flow to heart

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15
Q

what is included in ACS?

A

STEMI

NSTEMI

Unstable angina- chest pain at rest due to ischaemia but without caridac injury

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16
Q

what are the signs and symptoms of acute coronary syndrome?

A
  • Acute central chest pain –gripping/heavy
  • +/- radiation to neck, arm, jaw
  • Sweating
  • Pallor
  • +/- SOB
  • CAN BE SILENT IN OLD/DM
17
Q

what are the investigations for ACS?

A
  • ECG
  • Troponin

•Elevated indicates myocardial
injury as in a STEMI or NSTEMI

18
Q

what leads are the ST changes seen in and which artery is affected in an inferior MI

A

Leads II,III, aVF

right coronary artery

19
Q

what leads are the ST changes seen in and which artery is affected in an anteroseptal MI?

A

leads V1-V4

LAD

20
Q

what leads are the ST changes seen in and which artery is affected in an Anterolateral MI?

A

V4-V5, I, aVL

LAD or left circumflex

21
Q

what leads are the ST changes seen in and which artery is affected in a lateral MI?

A

I, AVL +- V5-6

left circumflex

22
Q

which leads are ST changes seen in a posterior MI and which artery is affected?

A

Dominant R wave V1-2

ST depression

leftcircumflex or right coronary artery

23
Q

describe the timing to decide the pathway for the management of a STEMI?

A

Establish time since symptom onset:

  1. <12hr since onset AND PCI available in 120mins?
    * PCI
  2. <12hr since onset AND PCI NOT available in 120mins?
    * THROMBOLYSIS
  3. >12hr since onset
    * ANGIOGRAPHY (look at arteries) then possible PCI
24
Q

what is the immediate and long term management of a STEMI?

A

•Morphine

•Oxygen- Give O2 if SaO2<90%

•Nitrates

•Aspirin- 300mg stat then 75mg after for 12 months

•Clopidogrel- 300mg stat then 75mg after for 12months

  • Beta-blocker
  • ACE-inhibitor- give within 24 hours
  • Statin
25
Q

what is the management of an NSTEMI?

A

Same as STEMI drugs but with LMWH ( fondaparinux/dalteparin/enoxaparin)

Determine risk via GRACE score: ( chances of having another cv event)

  • Low risk = outpatient angiography
  • Moderate/high risk = inpatient angiographywith possible PCI
  • Also give GpIIb/IIIa inhibitors (abciximab)
26
Q

what are the complications of MI?

A

Death

Arrhythmias

Rupture – of septum or outer walls - if papillary muscle rupture then murmur, etc

Tamponade

Heart failure

Valve disease - e.g. MR

Aneurysm

Dressler’s syndrome – autoimmune pericarditis 2-10 weeks after MI due to molecular mimicry

Embolism

Reinfarction

27
Q

What are the ECG changes seen in a STEMI?

A

Hyperacute T waves

ST elevation

New LBBB

REMEMBER ST ELEVATION OR DEPRESSION ARE SIGNS OF UNGOING ISCHAEMIA BUT INVERTED T WAVES ALONE ARE SIGNS OF PAST ISCHAEMIA

28
Q

What are the ECG changes seen in an NSTEMI/unstable angina?

A

ST depression

T wave inversion

REMEMBER ST ELEVATION OR DEPRESSION ARE SIGNS OF UNGOING ISCHAEMIA BUT INVERTED T WAVES ALONE ARE SIGNS OF PAST ISCHAEMIA

29
Q

what may be seen in an old infarct?

A

pathological q waves

30
Q

When is a q wave identified as pathological?

A
  • >= 0.02ms in V2, V3
  • >=0.03s or >=1mm depth (>25%) of adjacent R wave.
  • Needs to be in 2 contiguous leads

Cardiology (35 decks)

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