IHD Flashcards
Define IHD?
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
summarise the branches of IHD?
what are the risk factors for IHD?
Hypertension
Smoking
Diabetes
Family History
Previous Medical History
Hyperlipidaemia
what are the signs of hyperlipidaemia?
corneal arcus
xanthelasma
Define stable angina?
Chest pain brought on during exertion and relieved by rest due to myocardial ischaemia most often from atherosclerotic plaques
what is seen on examination in stable angina?
normal examination in chronic stable angina
what are the investigations for IHD?
Bloods –inclipids, FBC, glucose
ECG
what is the conservative mangement for stable angina?
- Weight loss
- Improved diet
- Smoking cessation
what is the medical management for stable angina?
- Drugs:
- ACEi
- Antiplatelet (aspirin)
- Statins
- Anti-anginals(beta-blocker/calcium-channel blocker)
- GTN spray
describe the vessel in stable angina and describe the ECG and trop?
angina develops when there is increased demand in setting of a stable atherosclerotic plaque
ECG- normal
trop- normal
describe the vessel in unstable angina, the ECG and trop?
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
describe the vessel in a NSTEMI, ECG and trop?
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
describe the vessel in a STEMI, the ECG and trop?
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
define ACS?
Range of condition due to sudden reduction in blood flow to heart
what is included in ACS?
STEMI
NSTEMI
Unstable angina- chest pain at rest due to ischaemia but without caridac injury
what are the signs and symptoms of acute coronary syndrome?
- Acute central chest pain –gripping/heavy
- +/- radiation to neck, arm, jaw
- Sweating
- Pallor
- +/- SOB
- CAN BE SILENT IN OLD/DM
what are the investigations for ACS?
- ECG
- Troponin
•Elevated indicates myocardial
injury as in a STEMI or NSTEMI
what leads are the ST changes seen in and which artery is affected in an inferior MI
Leads II,III, aVF
right coronary artery
what leads are the ST changes seen in and which artery is affected in an anteroseptal MI?
leads V1-V4
LAD
what leads are the ST changes seen in and which artery is affected in an Anterolateral MI?
V4-V5, I, aVL
LAD or left circumflex
what leads are the ST changes seen in and which artery is affected in a lateral MI?
I, AVL +- V5-6
left circumflex
which leads are ST changes seen in a posterior MI and which artery is affected?
Dominant R wave V1-2
ST depression
leftcircumflex or right coronary artery
describe the timing to decide the pathway for the management of a STEMI?
Establish time since symptom onset:
- <12hr since onset AND PCI available in 120mins?
* PCI - <12hr since onset AND PCI NOT available in 120mins?
* THROMBOLYSIS - >12hr since onset
* ANGIOGRAPHY (look at arteries) then possible PCI
what is the immediate and long term management of a STEMI?
•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
what is the management of an NSTEMI?
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)
what are the complications of MI?
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
What are the ECG changes seen in a STEMI?
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
What are the ECG changes seen in an NSTEMI/unstable angina?
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
what may be seen in an old infarct?
pathological q waves
When is a q wave identified as pathological?
- >= 0.02ms in V2, V3
- >=0.03s or >=1mm depth (>25%) of adjacent R wave.
- Needs to be in 2 contiguous leads
