*Ischaemic Heart Disease (1) Flashcards
What are 2 other names interchangeable with ischaemic heart disease?
Coronary artery disease
Coronary 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 supply Infarction = 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 IHD
Association between long QT interval and SCD in IHD
Incidence 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 VF
Severely 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 ischaemia
During 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)
Exertion
Stress
Cold wind
After meals
Some GI tract problems which could be a differential diagnosis of chest pain?
Reflux
Peptic ulcer pain
Oesophageal spasm
Biliary colic (unusual to be confused with angina)
Differential diagnosis for chest pain? (4)
GI tract e.g. reflux, oesophageal spasm
Musculoskeletal
Pericarditis
Pleuritic pain
What is angor animi?
Symptom defined as a patient’s perception that they are dying
3 emergency conditions that can cause chest pain?
MI
PE
Dissection 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 ECG
Myocardial perfusion scan
CT angiography
Angiography
What are some of the problems caused by the contrast used in angiography? (3)
Renal dysfunction
Rash
Nausea
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?
Drugs
Lifestyle (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?
Death Stroke MI Atrial fibrillation Infection Cognitive impairment Sternal malunion Renal 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?
Death Stroke MI Renal failure Bleeding Vascular complicaitons Stent thrombosis Stent 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 given
A catheter is passed to the osmium of the coronary
Guidewire is passed down the vessel
Balloons threaded over wire and stent implanted
Balloon, 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 symptoms
If 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 therapy
Vascular access
Advantages of using the radial artery as access for PCI?
Dual supply to hand
Superficial
No adjacent nerve/vein
Disadvantages of using the radial artery for access for PCI?
Smaller
Prone to spasm
Asymptomatic occlusion 5%
Haematoma?
Localised collection of blood outside the blood vessels
Does primary PCI or thrombolysis have fewer side effects?
Primary PCI
