Ischaemic Heart Disease

Question 1

What are the risk factors for atherosclerosis?

Answer 1

Smoking, Age, Male sex, Obesity, Hypercholesterolaemia, Diabetes, Family history, HPT

Question 2

What are the symptoms of stable angina?

Answer 2

Retrosternal dull pain/discomfort on exertion, relieved by rest or nitrates

Question 3

What is an acute coronary syndrome (unstable angina and myocardial infarction)?

Answer 3

It includes: ST-elevation myocardial infarction (STEMI), Non-ST elevation myocardial infarction (NSTEMI), Unstable angina. Caused by rupture of plaque/thrombosis.

Question 4

What happens to an atherosclerotic plaque to cause thrombosis in acute coronary syndromes?

Answer 4

Rupture

Question 5

Characteristics of chest pain: IHD

Answer 5

Central, tight or heavy, may radiate to the left arm/jaw

Question 6

Characteristics of chest pain: Pleuritic chest

pain

Answer 6

Sharp, not related to exertion, exacerbated on inspiration and alleviated by sitting up/leaning forward

Characteristically increases with inspiration and worsens on deep breathing Localised and sharp chest pain

Question 7

Characteristics of chest pain: Pericardial disease

Answer 7

Pleuritic like, exacerbated on lying down
Severe, sharp, retrosternal chest pain often radiating to
the neck, shoulder or back
Pain is often worsened with movement and inspiration
and relieved with istting upright and leaning forward

Question 8

Characteristics of chest pain: Gastrooesophageal

reflux (GERD)

Answer 8

Angina-like, not related to exertion, after meals,

exacerbated by lying down

Question 9

Characteristics of chest pain: Musculoskeletal

Answer 9

Sharp, small localisation, exacerbated on inspiration/
movement
Worse with movement and sometimes also increases on inspiration Tender chest wall

Question 10

Characteristics of chest pain: Dissection of thoracic aorta

Answer 10

Severe, tearing, sudden onset, radiates to back

Very sudden onset of chest pain which radiates to the back

Question 11

What, on general examination, are the signs of dyslipidaemia and familial hypercholesterolaemia?

Answer 11

Tendon xanthoma, Xanthalasma, Levels greater than 7.5 mmol/l

Question 12

If there is atherosclerosis of the Carotid arteries and peripheral vessels (peripheral vascular disease) what will be the clinical signs?

Answer 12

• Carotid – Loss of Consciousness, Depressed level of consciousness, Syncope
A bruit may be heard due to narrowed vessel.
• Peripheral – Cyanosis, Corneal arcus, Pulmonary embolus, Chest pain (MI)
Painful, pulseless, pale, paralysed limbs

Question 13

ECG: Ischaemia

Answer 13

ST elevation

Question 14

ECG: Transmural

Answer 14

Pathological Q wave