Ischaemic Heart Disease

Question 1

What are common causes of chest pain?

Answer 1

Skin (shingles)
MSK 
Vascular 
Respiratory
GI
Cardiac

Question 2

What are MSK causes of chest pain?

Answer 2

Costochondritis

Rib fractures

Question 3

What are vascualr causes of chest pain?

Answer 3

Aortic dissection

Question 4

WHat are GI causes of chest pain?

Answer 4

GORD (burning sesnation worsened why laying down)

Peptic Ulcer disease (high abdo confused for chest)

Question 5

What are respiratory causes of chest pain?

Answer 5

Pleurisy (imflammation of the plura)
-from pneumonia/ embolism

Have general unwellness/ breathlessness

Question 6

What are the two types if chest pain?

Answer 6

Cardiac

Pleuritic

Question 7

What is cardiac chest pain?

Answer 7

Dull/ heavy 
Poorly localised
Central 
Worsened with exercise 
Get referred pain

From visceral afferent nerves

Question 8

What is pleuritic chest pain?

Answer 8

Sharp
Well localised
Non central
Worsened by movements

Via somatic afferent nerves

Question 9

What is pericarditis?

Answer 9

Inflamation of the pericardium

Question 10

How does pericarditis present?

Answer 10

Sharp pain behind stermun
Aggrivated by breathing

Pericardial rub heart murmour

Widespread ST elevations across all leads

Question 11

What is acute coronary syndrome?

Answer 11

Spectrum of myocardial ischaemia/ infarctions

Question 12

What are the conditions classed as acute coronary syndromes?

Answer 12

Unstable angina
NSTEMI
STEMI

Question 13

What is the difference bewteen a NSTEMI and STEMI?

Answer 13

ST elevation in STEMI

In STEMI complete occlusion of coronary artery whrere as in NSTEMI only partial

Question 14

What invetigations would you do for an MI?

Answer 14

History (type of chest pain, autonomic symptoms)
Identify risk factors
Troponin blood test (elevated in MI)
ECG (ST segment abnormalities)
Echocardiogram (can see if area of heart walls damaged ect)

Question 15

How can you distinguish NSTEMI from unstable angina?

Answer 15

Troponin blood tests
NSTEMI levels will be raised
-this is due to cardiac myocyte death

Question 16

How does stable angina occour?

Answer 16

Atherosclerosis- stable occlusion of vessels

Have a stable atherosclerotic plaque (normally still able to get enough O2 delivery)

Question 17

How do Actute coronary syndromes develop?

Answer 17

Stable occlusion
Plaque rupture and platelet aggrigation
Thrombus formation
Sudden increased occlusion

Degree of increased occlusion determines type of syndrome

Question 18

What is the difference between stable and unstable angina?

Answer 18

Stable angina is relieved by rest (exercise related)

Unstable angina is present at rest (risk of leading to MI)

Question 19

How is (stable) angina managed?

Answer 19

GTN spray during episodes- causes venodilation (restore o2 balance to ischeamic heart)

B-blockers- reduce mycocardium o2 demand

Antiplatelet therpaies (eg Asprin)- reduce risk of platelet aggregation

Other treatments to reduce CV risk factors

Question 20

How is Unstable angina treated?

Answer 20

Simular to stable

Heparin (blood thinner reduce change of platelet formation)

Treatments to reduce CV risk factors

Question 21

How is a NSTEMI treated?

Answer 21

1) Antiplatelet and antithrombotic drugs (Asprin/ Enoxaparin)
2) Anti-ischaemics (B-blockers/ GTN)
3) Secondary prevention (reducing risk factors eg, statins and ACE inhibitors)

Question 22

In what circumstances does an NSTEMI need an urgent PCI?

Answer 22

If pateint has ongoing CP with dynamic ECG changes

If they develop arrythmias (eg VTs) suggests heart unstable

Question 23

How to manage a STEMI?

Answer 23

URGENT

1) Asprin (reduce platelet aggregation)
2) Morphine (and antisickness for pain)
3) GTN spray (reduces some symptoms)
4) O2 if have low sats
5) Transfer to cath labs for PCI

Question 24

What is a PCI?

Answer 24

Percutaneous coronary intervention

Catherter inserted to peripheral artery + directed to site of occlusion
Balloon inflated (this compressed thrombus and plaque)
Artery made patient
Stent inserted (restores normal blood flow in longer term)